| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,334 |
13,298 |
$778K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,353 |
817 |
$641K |
| D1120 |
Prophylaxis - child |
13,206 |
13,143 |
$508K |
| D0230 |
Intraoral - periapical each additional radiographic image |
105,149 |
20,181 |
$420K |
| D1110 |
Prophylaxis - adult |
4,684 |
4,670 |
$374K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,262 |
5,243 |
$338K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,382 |
2,750 |
$292K |
| D0340 |
|
5,494 |
5,451 |
$269K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,204 |
18,147 |
$234K |
| D0274 |
Bitewings - four radiographic images |
9,441 |
9,423 |
$198K |
| D0330 |
Panoramic radiographic image |
5,741 |
5,722 |
$169K |
| D4341 |
|
2,308 |
660 |
$161K |
| D2954 |
|
1,502 |
953 |
$156K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,801 |
3,469 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,590 |
1,630 |
$139K |
| D1351 |
Sealant - per tooth |
5,439 |
1,720 |
$139K |
| D4910 |
|
1,486 |
1,485 |
$114K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
956 |
469 |
$113K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
226 |
204 |
$104K |
| D1310 |
|
2,148 |
2,140 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,509 |
826 |
$86K |
| D2740 |
Crown - porcelain/ceramic |
179 |
109 |
$85K |
| D9993 |
|
1,245 |
1,241 |
$76K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,141 |
556 |
$74K |
| D9430 |
|
1,782 |
1,770 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,644 |
4,583 |
$55K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
121 |
83 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
410 |
314 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
296 |
153 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,304 |
2,289 |
$26K |
| D0350 |
|
1,986 |
970 |
$17K |
| D2160 |
|
201 |
135 |
$15K |
| D4342 |
|
361 |
137 |
$15K |
| D3310 |
|
50 |
29 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
370 |
370 |
$12K |
| D0603 |
|
807 |
802 |
$12K |
| D9221 |
|
19 |
12 |
$12K |
| D3320 |
|
30 |
25 |
$11K |
| D9222 |
|
82 |
82 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
76 |
41 |
$8K |
| D0601 |
|
384 |
380 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
142 |
141 |
$5K |
| D9610 |
|
121 |
81 |
$5K |
| D2999 |
|
65 |
56 |
$5K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
72 |
$3K |
| D9220 |
|
12 |
12 |
$3K |
| D2330 |
|
16 |
12 |
$1K |
| D0602 |
|
12 |
12 |
$180.00 |
| D0270 |
|
12 |
12 |
$60.00 |