| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,725 |
4,552 |
$194K |
| D0120 |
Periodic oral evaluation - established patient |
4,443 |
4,287 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,426 |
1,413 |
$116K |
| D1110 |
Prophylaxis - adult |
2,260 |
2,147 |
$95K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
649 |
441 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,873 |
1,161 |
$56K |
| D1120 |
Prophylaxis - child |
6,758 |
6,545 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
431 |
265 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,440 |
1,269 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
720 |
680 |
$37K |
| D8660 |
|
384 |
374 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,995 |
5,850 |
$32K |
| D1351 |
Sealant - per tooth |
5,466 |
1,454 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,803 |
7,552 |
$25K |
| D0340 |
|
398 |
364 |
$20K |
| D7111 |
|
900 |
551 |
$18K |
| D1330 |
|
8,040 |
7,781 |
$11K |
| D0274 |
Bitewings - four radiographic images |
4,337 |
4,193 |
$11K |
| D0330 |
Panoramic radiographic image |
747 |
717 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
6,942 |
6,576 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
916 |
857 |
$8K |
| D8670 |
Periodic orthodontic treatment visit |
139 |
104 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
244 |
244 |
$6K |
| D9310 |
|
723 |
681 |
$5K |
| D0272 |
Bitewings - two radiographic images |
1,679 |
1,626 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
194 |
106 |
$4K |
| D2394 |
|
25 |
18 |
$2K |
| D1354 |
|
45 |
16 |
$271.14 |
| D1206 |
Topical application of fluoride varnish |
363 |
348 |
$232.89 |
| D2330 |
|
31 |
12 |
$160.33 |
| D3120 |
|
40 |
27 |
$78.35 |
| D0470 |
|
39 |
35 |
$64.88 |
| D0350 |
|
360 |
328 |
$40.00 |