| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,118 |
13,114 |
$458K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,239 |
3,357 |
$453K |
| D1120 |
Prophylaxis - child |
11,432 |
11,428 |
$368K |
| D0274 |
Bitewings - four radiographic images |
11,659 |
11,654 |
$345K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,577 |
17,572 |
$322K |
| D1110 |
Prophylaxis - adult |
5,250 |
5,249 |
$236K |
| D0220 |
Intraoral - periapical first radiographic image |
19,039 |
18,916 |
$217K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,471 |
736 |
$164K |
| D0140 |
Limited oral evaluation - problem focused |
4,805 |
4,750 |
$142K |
| D9243 |
|
1,923 |
932 |
$133K |
| D7240 |
Removal of impacted tooth - completely bony |
694 |
314 |
$128K |
| D9239 |
|
998 |
990 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,227 |
1,391 |
$121K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,557 |
12,481 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
4,711 |
4,708 |
$107K |
| D0330 |
Panoramic radiographic image |
2,148 |
2,146 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
1,313 |
1,293 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
775 |
506 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
926 |
486 |
$61K |
| D1351 |
Sealant - per tooth |
2,217 |
559 |
$54K |
| D7241 |
|
227 |
139 |
$47K |
| D4346 |
|
368 |
367 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,480 |
1,354 |
$41K |
| D7230 |
|
190 |
112 |
$30K |
| D0272 |
Bitewings - two radiographic images |
263 |
263 |
$5K |
| D2331 |
|
26 |
13 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18 |
13 |
$2K |
| D2394 |
|
19 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
92 |
92 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
12 |
$1K |