| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,377 |
11,333 |
$617K |
| D1120 |
Prophylaxis - child |
10,778 |
10,730 |
$407K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,369 |
6,353 |
$395K |
| D1351 |
Sealant - per tooth |
12,283 |
3,611 |
$342K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,947 |
2,859 |
$332K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,537 |
14,169 |
$283K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,396 |
1,168 |
$281K |
| D0210 |
Intraoral - complete series of radiographic images |
4,623 |
4,607 |
$216K |
| D0274 |
Bitewings - four radiographic images |
8,074 |
8,031 |
$166K |
| D4341 |
|
2,417 |
965 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,141 |
12,084 |
$148K |
| D2140 |
|
2,601 |
1,755 |
$141K |
| D1110 |
Prophylaxis - adult |
1,790 |
1,780 |
$139K |
| D2160 |
|
1,443 |
948 |
$115K |
| D1310 |
|
1,489 |
1,484 |
$67K |
| D9430 |
|
1,532 |
1,519 |
$48K |
| D9993 |
|
720 |
719 |
$46K |
| D0272 |
Bitewings - two radiographic images |
3,627 |
3,609 |
$42K |
| D0350 |
|
4,169 |
2,350 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,009 |
978 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
653 |
264 |
$37K |
| D0330 |
Panoramic radiographic image |
1,643 |
1,637 |
$35K |
| D4342 |
|
691 |
271 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
791 |
791 |
$27K |
| D4910 |
|
292 |
292 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,854 |
1,832 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
106 |
65 |
$12K |
| D9910 |
|
251 |
251 |
$12K |
| D0603 |
|
714 |
713 |
$10K |
| D1206 |
Topical application of fluoride varnish |
541 |
538 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
70 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
44 |
27 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
25 |
$2K |
| D2330 |
|
25 |
12 |
$2K |
| D0601 |
|
107 |
107 |
$2K |
| D2954 |
|
13 |
13 |
$1K |
| D1330 |
|
681 |
669 |
$0.00 |