| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,883 |
5,819 |
$414K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,641 |
3,624 |
$196K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,051 |
929 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
557 |
370 |
$35K |
| D1351 |
Sealant - per tooth |
6,661 |
1,838 |
$26K |
| D1330 |
|
7,410 |
7,336 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
891 |
562 |
$24K |
| D0330 |
Panoramic radiographic image |
3,824 |
3,794 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
253 |
253 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,667 |
6,604 |
$17K |
| D0272 |
Bitewings - two radiographic images |
7,994 |
7,897 |
$13K |
| D0601 |
|
1,219 |
1,217 |
$12K |
| D1120 |
Prophylaxis - child |
4,109 |
4,072 |
$12K |
| D1110 |
Prophylaxis - adult |
2,884 |
2,857 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
9,384 |
9,253 |
$8K |
| D4355 |
|
373 |
370 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,020 |
8,840 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
135 |
125 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
12 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
260 |
259 |
$3K |
| D0603 |
|
212 |
209 |
$3K |
| D1206 |
Topical application of fluoride varnish |
423 |
419 |
$3K |
| D9310 |
|
60 |
60 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
27 |
$1K |
| D0340 |
|
41 |
41 |
$326.37 |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$0.00 |
| D0602 |
|
72 |
71 |
$0.00 |