| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
15,570 |
15,522 |
$804K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,958 |
8,922 |
$549K |
| D1120 |
Prophylaxis - child |
14,274 |
14,215 |
$529K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46,066 |
20,914 |
$437K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,369 |
1,760 |
$292K |
| D0274 |
Bitewings - four radiographic images |
15,923 |
15,858 |
$290K |
| D0210 |
Intraoral - complete series of radiographic images |
5,624 |
5,602 |
$256K |
| D1110 |
Prophylaxis - adult |
3,013 |
3,003 |
$248K |
| D2140 |
|
4,321 |
1,742 |
$233K |
| D4341 |
|
3,047 |
1,026 |
$202K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,688 |
540 |
$196K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,498 |
781 |
$176K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,746 |
556 |
$172K |
| D1206 |
Topical application of fluoride varnish |
11,922 |
11,880 |
$133K |
| D1351 |
Sealant - per tooth |
4,048 |
1,019 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,792 |
782 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,577 |
679 |
$89K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
186 |
162 |
$86K |
| D2740 |
Crown - porcelain/ceramic |
179 |
117 |
$84K |
| D0350 |
|
9,144 |
3,390 |
$79K |
| D2160 |
|
907 |
534 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,500 |
4,478 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
913 |
415 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
719 |
280 |
$57K |
| D9430 |
|
1,504 |
1,451 |
$46K |
| D1320 |
|
2,729 |
2,700 |
$44K |
| D9993 |
|
589 |
589 |
$36K |
| D1310 |
|
755 |
751 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,275 |
2,264 |
$26K |
| D2330 |
|
273 |
142 |
$20K |
| D4342 |
|
362 |
161 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
360 |
355 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
392 |
392 |
$14K |
| D0330 |
Panoramic radiographic image |
584 |
581 |
$12K |
| D7230 |
|
59 |
26 |
$11K |
| D0603 |
|
374 |
374 |
$5K |
| D4910 |
|
66 |
65 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
426 |
412 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
65 |
65 |
$3K |
| D2954 |
|
17 |
14 |
$2K |
| D0601 |
|
108 |
108 |
$2K |
| D0270 |
|
133 |
133 |
$660.00 |
| D0602 |
|
27 |
27 |
$382.50 |
| D9248 |
|
12 |
12 |
$35.00 |
| D1330 |
|
251 |
224 |
$0.00 |