| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,167 |
8,160 |
$470K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,416 |
3,084 |
$353K |
| D1120 |
Prophylaxis - child |
8,132 |
8,125 |
$312K |
| D1110 |
Prophylaxis - adult |
3,463 |
3,455 |
$294K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,217 |
1,436 |
$262K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,973 |
3,970 |
$248K |
| D0230 |
Intraoral - periapical each additional radiographic image |
50,042 |
9,378 |
$200K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,484 |
1,968 |
$184K |
| D0210 |
Intraoral - complete series of radiographic images |
3,892 |
3,891 |
$181K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,116 |
1,427 |
$173K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,982 |
11,971 |
$163K |
| D1351 |
Sealant - per tooth |
5,436 |
1,869 |
$156K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,955 |
1,432 |
$152K |
| D0274 |
Bitewings - four radiographic images |
4,799 |
4,796 |
$98K |
| D0350 |
|
9,248 |
4,087 |
$96K |
| D1310 |
|
2,022 |
2,020 |
$91K |
| D4341 |
|
1,152 |
306 |
$80K |
| D9430 |
|
2,474 |
2,283 |
$78K |
| D9993 |
|
974 |
974 |
$61K |
| D4910 |
|
760 |
760 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,202 |
4,064 |
$49K |
| D2330 |
|
582 |
336 |
$44K |
| D9248 |
|
866 |
848 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,445 |
2,441 |
$29K |
| D0603 |
|
1,566 |
1,563 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
101 |
101 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23 |
12 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
12 |
$2K |
| D4342 |
|
47 |
12 |
$2K |
| D0602 |
|
79 |
79 |
$1K |
| D1999 |
|
15 |
15 |
$0.00 |