| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
20,675 |
19,587 |
$11.02M |
| D1206 |
Topical application of fluoride varnish |
30,007 |
28,692 |
$9.11M |
| D0140 |
Limited oral evaluation - problem focused |
17,465 |
16,495 |
$3.64M |
| D0120 |
Periodic oral evaluation - established patient |
8,408 |
8,141 |
$1.48M |
| D7140 |
Extraction, erupted tooth or exposed root |
12,746 |
7,687 |
$1.39M |
| D0274 |
Bitewings - four radiographic images |
3,835 |
3,727 |
$929K |
| D1351 |
Sealant - per tooth |
15,048 |
2,825 |
$847K |
| D0272 |
Bitewings - two radiographic images |
1,339 |
1,308 |
$485K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,770 |
3,691 |
$442K |
| D0330 |
Panoramic radiographic image |
918 |
877 |
$264K |
| D0270 |
|
5,560 |
5,265 |
$120K |
| D1120 |
Prophylaxis - child |
1,650 |
1,620 |
$112K |
| D0145 |
Oral evaluation for a patient under three years of age |
266 |
264 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
298 |
211 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
475 |
284 |
$63K |
| D2940 |
|
331 |
192 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
215 |
204 |
$36K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
222 |
136 |
$25K |
| D1110 |
Prophylaxis - adult |
323 |
319 |
$20K |
| D2140 |
|
178 |
102 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,341 |
797 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
16 |
$8K |
| D2330 |
|
144 |
57 |
$6K |
| D2160 |
|
34 |
24 |
$4K |
| D9920 |
|
44 |
41 |
$3K |
| D9310 |
|
26 |
26 |
$0.00 |
| D1354 |
|
2,482 |
575 |
$0.00 |
| D0460 |
|
834 |
635 |
$0.00 |