| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
6,578 |
6,036 |
$220K |
| D0120 |
Periodic oral evaluation - established patient |
8,419 |
7,820 |
$197K |
| D1206 |
Topical application of fluoride varnish |
9,869 |
9,210 |
$145K |
| D8670 |
Periodic orthodontic treatment visit |
2,118 |
2,014 |
$143K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
306 |
287 |
$117K |
| D1120 |
Prophylaxis - child |
4,493 |
4,188 |
$110K |
| D1110 |
Prophylaxis - adult |
2,224 |
2,046 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,303 |
572 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
4,427 |
3,897 |
$58K |
| D1351 |
Sealant - per tooth |
3,186 |
851 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,088 |
961 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
393 |
300 |
$30K |
| D0330 |
Panoramic radiographic image |
868 |
781 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,886 |
1,733 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
250 |
202 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
602 |
517 |
$24K |
| D0274 |
Bitewings - four radiographic images |
449 |
393 |
$9K |
| D3310 |
|
25 |
25 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
30 |
26 |
$5K |
| D0270 |
|
1,089 |
1,032 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
375 |
217 |
$4K |
| D1354 |
|
790 |
270 |
$4K |
| D2330 |
|
19 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$729.75 |
| D0170 |
|
15 |
15 |
$464.25 |
| D0240 |
|
12 |
12 |
$200.52 |
| D9310 |
|
16 |
14 |
$0.00 |
| D0460 |
|
2,821 |
2,574 |
$0.00 |