| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,489 |
10,421 |
$274K |
| D1120 |
Prophylaxis - child |
7,117 |
7,069 |
$198K |
| D1110 |
Prophylaxis - adult |
3,601 |
3,571 |
$139K |
| D1206 |
Topical application of fluoride varnish |
8,335 |
8,274 |
$138K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,396 |
1,309 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,936 |
1,924 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,514 |
2,492 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
909 |
891 |
$41K |
| D0330 |
Panoramic radiographic image |
765 |
751 |
$32K |
| D0160 |
|
344 |
342 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
152 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,296 |
1,288 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
555 |
543 |
$20K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
120 |
45 |
$18K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
124 |
110 |
$17K |
| D0240 |
|
802 |
411 |
$13K |
| D1351 |
Sealant - per tooth |
444 |
104 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
102 |
44 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
154 |
81 |
$10K |
| D9222 |
|
121 |
117 |
$9K |
| D9612 |
|
122 |
118 |
$7K |
| D7240 |
Removal of impacted tooth - completely bony |
31 |
13 |
$6K |
| D9248 |
|
1,099 |
1,042 |
$5K |
| D7230 |
|
28 |
14 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
269 |
264 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
33 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
13 |
$1K |
| D2140 |
|
16 |
12 |
$1K |