| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,073 |
6,058 |
$384K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,219 |
2,562 |
$346K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,525 |
863 |
$297K |
| D0120 |
Periodic oral evaluation - established patient |
4,391 |
4,360 |
$281K |
| D0210 |
Intraoral - complete series of radiographic images |
4,771 |
4,760 |
$224K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,655 |
1,714 |
$196K |
| D1120 |
Prophylaxis - child |
4,445 |
4,420 |
$176K |
| D1110 |
Prophylaxis - adult |
1,613 |
1,604 |
$139K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,079 |
6,817 |
$128K |
| D9430 |
|
2,770 |
2,697 |
$88K |
| D0274 |
Bitewings - four radiographic images |
4,328 |
4,296 |
$79K |
| D1351 |
Sealant - per tooth |
2,781 |
608 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,825 |
4,801 |
$60K |
| D2740 |
Crown - porcelain/ceramic |
82 |
68 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
290 |
196 |
$23K |
| D0350 |
|
2,170 |
726 |
$21K |
| D1320 |
|
658 |
650 |
$11K |
| D4341 |
|
142 |
55 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$6K |
| D7240 |
Removal of impacted tooth - completely bony |
28 |
12 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
161 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
28 |
$5K |
| D2330 |
|
54 |
26 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
333 |
330 |
$4K |
| D0272 |
Bitewings - two radiographic images |
341 |
341 |
$4K |
| D0330 |
Panoramic radiographic image |
503 |
501 |
$4K |
| D9993 |
|
53 |
53 |
$3K |
| D1310 |
|
53 |
53 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
41 |
41 |
$2K |
| D4910 |
|
12 |
12 |
$924.00 |
| D0270 |
|
144 |
138 |
$695.00 |