| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
70,698 |
9,501 |
$290K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
560 |
374 |
$267K |
| D8670 |
Periodic orthodontic treatment visit |
937 |
931 |
$264K |
| D0120 |
Periodic oral evaluation - established patient |
4,782 |
4,772 |
$256K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,796 |
1,859 |
$253K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,840 |
3,830 |
$243K |
| D1120 |
Prophylaxis - child |
5,252 |
5,237 |
$190K |
| D1110 |
Prophylaxis - adult |
1,606 |
1,601 |
$137K |
| D1351 |
Sealant - per tooth |
4,788 |
1,489 |
$119K |
| D2140 |
|
1,465 |
824 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,934 |
6,915 |
$77K |
| D0272 |
Bitewings - two radiographic images |
5,651 |
5,632 |
$66K |
| D7111 |
|
1,028 |
528 |
$59K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
122 |
101 |
$56K |
| D4341 |
|
583 |
156 |
$41K |
| D2160 |
|
395 |
267 |
$31K |
| D2954 |
|
263 |
182 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
784 |
782 |
$27K |
| D0330 |
Panoramic radiographic image |
860 |
860 |
$24K |
| D0274 |
Bitewings - four radiographic images |
819 |
819 |
$17K |
| D7240 |
Removal of impacted tooth - completely bony |
63 |
27 |
$15K |
| D0350 |
|
1,271 |
524 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
241 |
241 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
948 |
941 |
$11K |
| D9430 |
|
151 |
147 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
13 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
12 |
$3K |
| D4910 |
|
12 |
12 |
$924.00 |