| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,091 |
12,039 |
$600K |
| D1110 |
Prophylaxis - adult |
6,362 |
6,330 |
$242K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,450 |
1,938 |
$171K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,166 |
2,160 |
$129K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,112 |
741 |
$117K |
| D1330 |
|
14,486 |
14,422 |
$74K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
482 |
307 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,676 |
1,028 |
$42K |
| D1120 |
Prophylaxis - child |
8,151 |
8,120 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,490 |
13,430 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,004 |
5,402 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
578 |
529 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
893 |
615 |
$19K |
| D0274 |
Bitewings - four radiographic images |
7,831 |
7,791 |
$18K |
| D9999 |
Unspecified adjunctive procedure, by report |
474 |
473 |
$17K |
| D0272 |
Bitewings - two radiographic images |
6,310 |
6,288 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
6,804 |
6,727 |
$11K |
| D1354 |
|
1,368 |
403 |
$10K |
| D1351 |
Sealant - per tooth |
695 |
200 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
702 |
696 |
$9K |
| D1510 |
|
57 |
54 |
$8K |
| D0330 |
Panoramic radiographic image |
206 |
206 |
$6K |
| D2394 |
|
14 |
14 |
$3K |
| D1999 |
|
51 |
51 |
$2K |
| D1206 |
Topical application of fluoride varnish |
347 |
346 |
$2K |
| D3120 |
|
287 |
229 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
23 |
23 |
$460.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$316.76 |
| D0603 |
|
511 |
492 |
$198.00 |
| D0602 |
|
287 |
283 |
$137.00 |
| D0601 |
|
243 |
243 |
$91.00 |