| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,437 |
5,416 |
$328K |
| D1120 |
Prophylaxis - child |
6,803 |
6,773 |
$284K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,634 |
7,052 |
$141K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,521 |
1,513 |
$97K |
| D1310 |
|
2,109 |
2,097 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,323 |
713 |
$88K |
| D1206 |
Topical application of fluoride varnish |
4,684 |
4,655 |
$79K |
| D9993 |
|
947 |
947 |
$59K |
| D0272 |
Bitewings - two radiographic images |
4,769 |
4,755 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
946 |
610 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,232 |
3,960 |
$50K |
| D1110 |
Prophylaxis - adult |
572 |
571 |
$49K |
| D1351 |
Sealant - per tooth |
1,418 |
365 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,172 |
1,107 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
832 |
404 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,967 |
2,965 |
$43K |
| D0350 |
|
4,056 |
1,980 |
$35K |
| D9110 |
|
438 |
425 |
$26K |
| D0603 |
|
1,538 |
1,528 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
90 |
43 |
$11K |
| D1354 |
|
442 |
440 |
$10K |
| D1320 |
|
954 |
952 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
154 |
152 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
88 |
42 |
$8K |
| D4341 |
|
97 |
25 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$7K |
| D9430 |
|
140 |
137 |
$4K |
| D2330 |
|
21 |
12 |
$2K |
| D2954 |
|
13 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$1K |
| D0601 |
|
80 |
80 |
$1K |
| D0160 |
|
12 |
12 |
$800.00 |
| D1999 |
|
141 |
131 |
$138.00 |