| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,399 |
11,376 |
$700K |
| D0120 |
Periodic oral evaluation - established patient |
13,414 |
13,375 |
$681K |
| D1120 |
Prophylaxis - child |
13,349 |
13,303 |
$485K |
| D8670 |
Periodic orthodontic treatment visit |
1,502 |
1,500 |
$425K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,029 |
21,592 |
$386K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,209 |
1,641 |
$378K |
| D4341 |
|
4,294 |
1,517 |
$289K |
| D1110 |
Prophylaxis - adult |
3,619 |
3,607 |
$279K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,865 |
2,255 |
$258K |
| D0274 |
Bitewings - four radiographic images |
11,845 |
11,788 |
$245K |
| D1351 |
Sealant - per tooth |
8,093 |
2,048 |
$197K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,754 |
1,717 |
$184K |
| D0210 |
Intraoral - complete series of radiographic images |
3,286 |
3,277 |
$153K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,245 |
523 |
$143K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,524 |
1,509 |
$137K |
| D1206 |
Topical application of fluoride varnish |
9,093 |
9,053 |
$132K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,119 |
486 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,853 |
860 |
$105K |
| D0272 |
Bitewings - two radiographic images |
6,265 |
6,242 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,192 |
7,171 |
$71K |
| D2140 |
|
1,287 |
843 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
2,036 |
1,995 |
$68K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,484 |
1,441 |
$58K |
| D0350 |
|
5,252 |
3,022 |
$51K |
| D4342 |
|
1,000 |
386 |
$41K |
| D4910 |
|
549 |
543 |
$39K |
| D1310 |
|
834 |
834 |
$38K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
76 |
70 |
$35K |
| D9910 |
|
574 |
572 |
$33K |
| D2160 |
|
348 |
249 |
$28K |
| D9993 |
|
408 |
408 |
$26K |
| D0330 |
Panoramic radiographic image |
760 |
752 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
169 |
128 |
$13K |
| D7240 |
Removal of impacted tooth - completely bony |
43 |
20 |
$10K |
| D2330 |
|
126 |
78 |
$10K |
| D7230 |
|
30 |
18 |
$5K |
| D0601 |
|
176 |
176 |
$3K |
| D0602 |
|
67 |
67 |
$930.00 |
| D9430 |
|
27 |
27 |
$864.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$826.00 |
| D0270 |
|
132 |
131 |
$645.00 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
27 |
$324.00 |
| D0603 |
|
12 |
12 |
$180.00 |
| D0190 |
|
27 |
27 |
$0.00 |
| D4921 |
|
516 |
142 |
$0.00 |
| D1330 |
|
5,667 |
5,645 |
$0.00 |
| D9920 |
|
20 |
20 |
$0.00 |