| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,308 |
11,988 |
$2.42M |
| D0140 |
Limited oral evaluation - problem focused |
14,230 |
13,417 |
$2.19M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,275 |
5,757 |
$1.22M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,383 |
5,252 |
$951K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,025 |
5,268 |
$820K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,008 |
3,910 |
$809K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
974 |
861 |
$199K |
| D1354 |
|
4,546 |
1,186 |
$177K |
| D2331 |
|
616 |
443 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
183 |
170 |
$47K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
497 |
381 |
$44K |
| D2330 |
|
751 |
517 |
$42K |
| D5899 |
|
551 |
352 |
$35K |
| D2335 |
|
136 |
115 |
$28K |
| D2140 |
|
481 |
309 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
109 |
109 |
$16K |
| D2394 |
|
28 |
26 |
$6K |
| D2160 |
|
28 |
25 |
$5K |
| D4341 |
|
27 |
15 |
$5K |
| D1110 |
Prophylaxis - adult |
11,194 |
10,938 |
$3K |
| D0330 |
Panoramic radiographic image |
6,862 |
6,689 |
$2K |
| D0274 |
Bitewings - four radiographic images |
13,293 |
12,957 |
$1K |
| D1120 |
Prophylaxis - child |
6,663 |
6,536 |
$1K |
| D1206 |
Topical application of fluoride varnish |
11,657 |
11,458 |
$498.44 |
| D4355 |
|
356 |
334 |
$315.81 |
| D0220 |
Intraoral - periapical first radiographic image |
8,131 |
7,839 |
$210.77 |
| D1351 |
Sealant - per tooth |
11,547 |
3,814 |
$185.30 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,080 |
625 |
$43.42 |
| D0272 |
Bitewings - two radiographic images |
1,169 |
1,146 |
$36.40 |
| D0270 |
|
2,479 |
2,424 |
$31.53 |
| D0240 |
|
372 |
193 |
$0.00 |
| D0603 |
|
23 |
23 |
$0.00 |
| D1310 |
|
116 |
115 |
$0.00 |
| D1330 |
|
94 |
94 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
55 |
$0.00 |
| D0602 |
|
16 |
16 |
$0.00 |
| D3120 |
|
19 |
12 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,960 |
2,592 |
$0.00 |
| D0180 |
|
16 |
13 |
$0.00 |