| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,984 |
5,959 |
$364K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
676 |
361 |
$319K |
| D1110 |
Prophylaxis - adult |
3,662 |
3,645 |
$304K |
| D3320 |
|
790 |
687 |
$285K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,379 |
1,259 |
$278K |
| D0210 |
Intraoral - complete series of radiographic images |
5,305 |
5,281 |
$247K |
| D0120 |
Periodic oral evaluation - established patient |
2,647 |
2,642 |
$141K |
| D3310 |
|
395 |
268 |
$119K |
| D9430 |
|
3,354 |
3,164 |
$104K |
| D4341 |
|
1,362 |
389 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,061 |
4,481 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,533 |
5,505 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
5,588 |
5,230 |
$65K |
| D1351 |
Sealant - per tooth |
2,613 |
553 |
$59K |
| D1120 |
Prophylaxis - child |
1,605 |
1,596 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,260 |
2,253 |
$47K |
| D2160 |
|
377 |
295 |
$30K |
| D2954 |
|
275 |
169 |
$28K |
| D4910 |
|
383 |
381 |
$28K |
| D2161 |
|
237 |
196 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
235 |
125 |
$13K |
| D2330 |
|
174 |
94 |
$13K |
| D2940 |
|
94 |
71 |
$6K |
| D2335 |
|
27 |
15 |
$3K |
| D0272 |
Bitewings - two radiographic images |
259 |
258 |
$3K |
| D0350 |
|
221 |
161 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
28 |
25 |
$2K |
| D4342 |
|
31 |
12 |
$1K |