| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,644 |
8,614 |
$474K |
| D1120 |
Prophylaxis - child |
10,800 |
10,761 |
$411K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,109 |
2,777 |
$396K |
| D7240 |
Removal of impacted tooth - completely bony |
1,357 |
550 |
$310K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,901 |
12,841 |
$241K |
| D1351 |
Sealant - per tooth |
8,603 |
2,462 |
$217K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,785 |
2,005 |
$200K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,193 |
3,188 |
$199K |
| D1206 |
Topical application of fluoride varnish |
11,839 |
11,796 |
$159K |
| D1310 |
|
2,419 |
2,409 |
$110K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
835 |
442 |
$94K |
| D0274 |
Bitewings - four radiographic images |
4,246 |
4,221 |
$88K |
| D9993 |
|
1,097 |
1,097 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
913 |
592 |
$71K |
| D9430 |
|
2,174 |
2,122 |
$69K |
| D0272 |
Bitewings - two radiographic images |
5,916 |
5,899 |
$68K |
| D0350 |
|
4,104 |
2,807 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
3,502 |
3,456 |
$41K |
| D7230 |
|
199 |
116 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
411 |
242 |
$23K |
| D0603 |
|
1,203 |
1,200 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
269 |
269 |
$17K |
| D0602 |
|
1,003 |
996 |
$15K |
| D2740 |
Crown - porcelain/ceramic |
24 |
14 |
$11K |
| D4910 |
|
125 |
125 |
$8K |
| D0330 |
Panoramic radiographic image |
255 |
255 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
50 |
30 |
$5K |
| D1110 |
Prophylaxis - adult |
42 |
42 |
$4K |
| D1320 |
|
136 |
136 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
15 |
$2K |
| D2160 |
|
16 |
12 |
$1K |
| D2140 |
|
20 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
31 |
$188.40 |