| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,823 |
8,658 |
$442K |
| D1120 |
Prophylaxis - child |
10,016 |
9,820 |
$347K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,964 |
2,264 |
$319K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,599 |
1,272 |
$138K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,026 |
9,824 |
$128K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,686 |
7,971 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,900 |
1,870 |
$110K |
| D1310 |
|
2,525 |
2,495 |
$108K |
| D1351 |
Sealant - per tooth |
3,128 |
1,012 |
$82K |
| D9993 |
|
1,459 |
1,437 |
$82K |
| D0274 |
Bitewings - four radiographic images |
3,387 |
3,343 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
1,321 |
1,311 |
$55K |
| D0350 |
|
4,056 |
1,924 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
456 |
280 |
$36K |
| D4341 |
|
415 |
112 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,180 |
2,137 |
$24K |
| D0603 |
|
1,495 |
1,474 |
$21K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
38 |
27 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
262 |
258 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
291 |
277 |
$11K |
| D4910 |
|
150 |
150 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
172 |
98 |
$9K |
| D7240 |
Removal of impacted tooth - completely bony |
38 |
16 |
$9K |
| D9999 |
Unspecified adjunctive procedure, by report |
65 |
65 |
$8K |
| D2954 |
|
68 |
44 |
$7K |
| D0602 |
|
253 |
251 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
15 |
$3K |
| D9430 |
|
55 |
51 |
$2K |
| D0330 |
Panoramic radiographic image |
44 |
44 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
293 |
236 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$831.60 |