| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
16,988 |
16,602 |
$971K |
| D0120 |
Periodic oral evaluation - established patient |
20,825 |
20,596 |
$762K |
| D1206 |
Topical application of fluoride varnish |
21,126 |
20,836 |
$609K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,374 |
4,257 |
$573K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,361 |
4,519 |
$551K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,068 |
2,376 |
$500K |
| D0274 |
Bitewings - four radiographic images |
11,385 |
11,243 |
$498K |
| D1120 |
Prophylaxis - child |
11,144 |
11,010 |
$438K |
| D1354 |
|
11,863 |
3,762 |
$425K |
| D0330 |
Panoramic radiographic image |
4,433 |
4,377 |
$364K |
| D0140 |
Limited oral evaluation - problem focused |
6,166 |
5,879 |
$236K |
| D1351 |
Sealant - per tooth |
6,605 |
2,014 |
$228K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,945 |
1,372 |
$189K |
| D2331 |
|
1,614 |
1,086 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,816 |
3,770 |
$165K |
| D0350 |
|
1,312 |
1,302 |
$113K |
| D0272 |
Bitewings - two radiographic images |
2,767 |
2,747 |
$92K |
| D2330 |
|
1,023 |
726 |
$86K |
| D1330 |
|
3,236 |
3,169 |
$83K |
| D2140 |
|
1,000 |
711 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
4,537 |
4,412 |
$75K |
| D2160 |
|
488 |
425 |
$57K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
262 |
103 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,666 |
2,217 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
370 |
317 |
$30K |
| D9410 |
|
925 |
793 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
158 |
133 |
$23K |
| D2335 |
|
108 |
78 |
$15K |
| D2332 |
|
94 |
76 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
495 |
299 |
$6K |
| D4355 |
|
68 |
68 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$851.88 |
| D9985 |
|
201 |
180 |
$48.53 |
| D7922 |
|
35 |
20 |
$0.00 |
| D9996 |
|
32 |
32 |
$0.00 |
| D3120 |
|
278 |
247 |
$0.00 |
| D9995 |
|
23 |
23 |
$0.00 |