| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,874 |
6,832 |
$458K |
| D1120 |
Prophylaxis - child |
9,674 |
9,615 |
$450K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,780 |
1,343 |
$435K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,627 |
6,600 |
$427K |
| D7240 |
Removal of impacted tooth - completely bony |
1,307 |
506 |
$289K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,832 |
1,736 |
$188K |
| D1310 |
|
3,861 |
3,846 |
$177K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,804 |
9,747 |
$176K |
| D2740 |
Crown - porcelain/ceramic |
347 |
290 |
$163K |
| D0210 |
Intraoral - complete series of radiographic images |
3,341 |
3,333 |
$159K |
| D1110 |
Prophylaxis - adult |
1,563 |
1,563 |
$134K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,542 |
2,444 |
$98K |
| D9430 |
|
2,768 |
2,737 |
$88K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,173 |
6,336 |
$87K |
| D0330 |
Panoramic radiographic image |
2,694 |
2,663 |
$79K |
| D0274 |
Bitewings - four radiographic images |
3,720 |
3,693 |
$77K |
| D1351 |
Sealant - per tooth |
2,377 |
631 |
$76K |
| D7230 |
|
325 |
182 |
$61K |
| D4341 |
|
845 |
227 |
$58K |
| D4910 |
|
625 |
624 |
$47K |
| D9993 |
|
724 |
723 |
$46K |
| D0603 |
|
2,544 |
2,533 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
644 |
359 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
608 |
390 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,682 |
2,668 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
392 |
392 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,659 |
1,657 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,480 |
1,466 |
$17K |
| D8670 |
Periodic orthodontic treatment visit |
51 |
50 |
$15K |
| D0601 |
|
771 |
770 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
14 |
$6K |
| D1354 |
|
515 |
109 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
59 |
53 |
$5K |
| D0350 |
|
257 |
112 |
$2K |
| D0340 |
|
33 |
33 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
33 |
$1K |
| D0470 |
|
33 |
33 |
$375.00 |
| D0270 |
|
13 |
13 |
$65.00 |