| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18,413 |
17,952 |
$467K |
| D1110 |
Prophylaxis - adult |
11,266 |
10,943 |
$420K |
| D4355 |
|
4,682 |
4,408 |
$306K |
| D0330 |
Panoramic radiographic image |
5,217 |
4,851 |
$281K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,888 |
10,510 |
$276K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,552 |
2,430 |
$276K |
| D1120 |
Prophylaxis - child |
9,878 |
9,666 |
$268K |
| D0220 |
Intraoral - periapical first radiographic image |
19,100 |
16,935 |
$251K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,100 |
14,700 |
$247K |
| D0140 |
Limited oral evaluation - problem focused |
6,913 |
6,533 |
$244K |
| D0274 |
Bitewings - four radiographic images |
7,478 |
7,126 |
$220K |
| D1351 |
Sealant - per tooth |
6,993 |
1,761 |
$190K |
| D2140 |
|
2,232 |
1,656 |
$162K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,534 |
3,399 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,713 |
2,587 |
$112K |
| D0272 |
Bitewings - two radiographic images |
4,751 |
4,629 |
$84K |
| D0240 |
|
4,979 |
4,578 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,306 |
919 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
736 |
652 |
$72K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
725 |
634 |
$66K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
262 |
233 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
524 |
481 |
$32K |
| D1206 |
Topical application of fluoride varnish |
395 |
388 |
$6K |
| D2330 |
|
116 |
84 |
$6K |
| D2332 |
|
23 |
12 |
$1K |
| D2950 |
|
12 |
12 |
$1K |