| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
23,462 |
23,178 |
$684K |
| D0120 |
Periodic oral evaluation - established patient |
35,315 |
34,809 |
$576K |
| D0274 |
Bitewings - four radiographic images |
14,078 |
13,912 |
$318K |
| D1206 |
Topical application of fluoride varnish |
18,263 |
17,997 |
$294K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,414 |
3,972 |
$280K |
| D1120 |
Prophylaxis - child |
13,569 |
13,332 |
$225K |
| D0330 |
Panoramic radiographic image |
3,920 |
3,874 |
$181K |
| D0140 |
Limited oral evaluation - problem focused |
6,084 |
5,921 |
$135K |
| D2140 |
|
3,127 |
2,195 |
$123K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,797 |
1,086 |
$117K |
| D2160 |
|
1,239 |
951 |
$81K |
| D2331 |
|
1,139 |
755 |
$76K |
| D1351 |
Sealant - per tooth |
3,609 |
967 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,074 |
4,000 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
7,857 |
7,534 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,267 |
828 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,483 |
1,021 |
$53K |
| D0272 |
Bitewings - two radiographic images |
3,281 |
3,237 |
$51K |
| D2740 |
Crown - porcelain/ceramic |
274 |
251 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,450 |
2,498 |
$23K |
| D2330 |
|
489 |
340 |
$17K |
| D2335 |
|
127 |
95 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
55 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
838 |
818 |
$6K |
| D2332 |
|
36 |
25 |
$4K |
| D4910 |
|
40 |
38 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
279 |
254 |
$1K |
| D2950 |
|
43 |
39 |
$499.65 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$360.96 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
12 |
$0.00 |
| D1999 |
|
298 |
265 |
$0.00 |