| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,988 |
8,955 |
$490K |
| D8670 |
Periodic orthodontic treatment visit |
1,078 |
1,078 |
$304K |
| D1120 |
Prophylaxis - child |
8,069 |
8,034 |
$301K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,923 |
10,386 |
$228K |
| D9430 |
|
6,694 |
6,108 |
$210K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,407 |
11,353 |
$137K |
| D7240 |
Removal of impacted tooth - completely bony |
553 |
228 |
$128K |
| D1110 |
Prophylaxis - adult |
1,313 |
1,307 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,956 |
1,111 |
$106K |
| D0274 |
Bitewings - four radiographic images |
4,079 |
4,052 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,216 |
822 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,228 |
1,225 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,076 |
1,074 |
$50K |
| D0272 |
Bitewings - two radiographic images |
4,207 |
4,197 |
$48K |
| D1351 |
Sealant - per tooth |
1,666 |
486 |
$46K |
| D4910 |
|
530 |
529 |
$41K |
| D0350 |
|
3,760 |
1,797 |
$39K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
73 |
57 |
$34K |
| D4341 |
|
378 |
99 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
382 |
372 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
191 |
109 |
$13K |
| D0340 |
|
205 |
205 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
851 |
837 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
175 |
90 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
88 |
54 |
$9K |
| D0330 |
Panoramic radiographic image |
251 |
251 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
61 |
40 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
60 |
36 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
131 |
131 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
16 |
$2K |
| D9993 |
|
13 |
13 |
$845.00 |
| D1310 |
|
13 |
13 |
$598.00 |