| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,908 |
8,886 |
$478K |
| D1110 |
Prophylaxis - adult |
5,139 |
5,121 |
$419K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,221 |
6,202 |
$379K |
| D1120 |
Prophylaxis - child |
7,976 |
7,957 |
$299K |
| D0210 |
Intraoral - complete series of radiographic images |
6,413 |
6,395 |
$297K |
| D1351 |
Sealant - per tooth |
9,336 |
2,316 |
$256K |
| D1206 |
Topical application of fluoride varnish |
14,841 |
14,796 |
$208K |
| D0230 |
Intraoral - periapical each additional radiographic image |
45,864 |
8,502 |
$190K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,853 |
1,880 |
$189K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,195 |
820 |
$142K |
| D9430 |
|
4,360 |
4,104 |
$135K |
| D0274 |
Bitewings - four radiographic images |
5,656 |
5,647 |
$119K |
| D1310 |
|
1,613 |
1,612 |
$73K |
| D9993 |
|
1,033 |
1,033 |
$61K |
| D4341 |
|
828 |
262 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
616 |
449 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,288 |
1,144 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
832 |
537 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,942 |
2,820 |
$34K |
| D0350 |
|
3,362 |
1,772 |
$32K |
| D1354 |
|
1,431 |
665 |
$24K |
| D0330 |
Panoramic radiographic image |
788 |
788 |
$23K |
| D2740 |
Crown - porcelain/ceramic |
45 |
40 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,777 |
1,772 |
$20K |
| D0603 |
|
1,288 |
1,285 |
$19K |
| D4910 |
|
121 |
121 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
151 |
90 |
$9K |
| D2954 |
|
15 |
13 |
$2K |
| D2330 |
|
19 |
13 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$364.00 |