| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
4,333 |
3,977 |
$196K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,563 |
1,125 |
$157K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,630 |
597 |
$135K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,794 |
907 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,884 |
4,498 |
$112K |
| D1110 |
Prophylaxis - adult |
3,173 |
2,975 |
$95K |
| D1206 |
Topical application of fluoride varnish |
5,425 |
5,050 |
$75K |
| D2394 |
|
932 |
512 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,183 |
569 |
$51K |
| D2335 |
|
588 |
278 |
$45K |
| D1120 |
Prophylaxis - child |
1,733 |
1,630 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
779 |
314 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,722 |
1,632 |
$33K |
| D4355 |
|
498 |
439 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,276 |
1,171 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
586 |
491 |
$23K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
15 |
15 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,479 |
1,378 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,032 |
1,808 |
$17K |
| D1351 |
Sealant - per tooth |
670 |
106 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,917 |
1,335 |
$12K |
| D4341 |
|
160 |
38 |
$10K |
| D0330 |
Panoramic radiographic image |
245 |
228 |
$9K |
| D8660 |
|
58 |
51 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
18 |
18 |
$3K |
| D2954 |
|
30 |
24 |
$3K |
| D0340 |
|
71 |
59 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
13 |
$2K |
| D0470 |
|
67 |
60 |
$2K |
| D0350 |
|
58 |
53 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
79 |
74 |
$949.78 |
| D0170 |
|
32 |
25 |
$504.09 |