| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,072 |
12,996 |
$869K |
| D1120 |
Prophylaxis - child |
18,884 |
18,801 |
$857K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,033 |
4,255 |
$529K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,882 |
5,879 |
$387K |
| D1310 |
|
7,930 |
7,915 |
$360K |
| D1351 |
Sealant - per tooth |
9,313 |
2,839 |
$310K |
| D0230 |
Intraoral - periapical each additional radiographic image |
73,852 |
14,874 |
$307K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,797 |
16,725 |
$280K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,678 |
5,333 |
$225K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,522 |
2,169 |
$187K |
| D1110 |
Prophylaxis - adult |
1,448 |
1,448 |
$126K |
| D0274 |
Bitewings - four radiographic images |
6,003 |
5,968 |
$125K |
| D9993 |
|
1,955 |
1,955 |
$125K |
| D0603 |
|
7,858 |
7,843 |
$116K |
| D0210 |
Intraoral - complete series of radiographic images |
2,403 |
2,402 |
$113K |
| D0340 |
|
2,220 |
2,199 |
$110K |
| D0350 |
|
11,690 |
5,700 |
$108K |
| D9430 |
|
2,988 |
2,888 |
$95K |
| D1206 |
Topical application of fluoride varnish |
3,945 |
3,935 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,235 |
753 |
$69K |
| D0330 |
Panoramic radiographic image |
2,014 |
1,998 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,156 |
4,119 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,378 |
1,361 |
$47K |
| D0145 |
Oral evaluation for a patient under three years of age |
666 |
666 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,919 |
2,910 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
247 |
135 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
365 |
242 |
$29K |
| D1320 |
|
1,960 |
1,960 |
$24K |
| D2740 |
Crown - porcelain/ceramic |
36 |
27 |
$17K |
| D7240 |
Removal of impacted tooth - completely bony |
60 |
28 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D2940 |
|
116 |
100 |
$5K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$4K |
| D4341 |
|
50 |
13 |
$4K |
| D2330 |
|
44 |
27 |
$3K |
| D2954 |
|
32 |
27 |
$3K |
| D1354 |
|
128 |
68 |
$2K |
| D4910 |
|
14 |
14 |
$1K |
| D0270 |
|
50 |
50 |
$250.00 |
| D9995 |
|
62 |
59 |
$151.44 |