| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,342 |
7,319 |
$459K |
| D0120 |
Periodic oral evaluation - established patient |
8,443 |
8,415 |
$457K |
| D1120 |
Prophylaxis - child |
6,499 |
6,474 |
$249K |
| D0210 |
Intraoral - complete series of radiographic images |
5,061 |
5,043 |
$238K |
| D1110 |
Prophylaxis - adult |
2,674 |
2,664 |
$234K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,858 |
986 |
$218K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,197 |
10,691 |
$199K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,672 |
1,827 |
$178K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,016 |
1,935 |
$164K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,710 |
8,677 |
$107K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,318 |
833 |
$88K |
| D0274 |
Bitewings - four radiographic images |
4,181 |
4,145 |
$87K |
| D0272 |
Bitewings - two radiographic images |
5,493 |
5,444 |
$64K |
| D2140 |
|
1,167 |
776 |
$63K |
| D0350 |
|
4,780 |
2,868 |
$44K |
| D8670 |
Periodic orthodontic treatment visit |
127 |
127 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
609 |
260 |
$35K |
| D4341 |
|
405 |
183 |
$28K |
| D1351 |
Sealant - per tooth |
1,043 |
320 |
$23K |
| D9430 |
|
623 |
613 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
497 |
458 |
$19K |
| D1310 |
|
376 |
376 |
$17K |
| D0330 |
Panoramic radiographic image |
683 |
680 |
$13K |
| D9993 |
|
176 |
176 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
309 |
308 |
$10K |
| D1206 |
Topical application of fluoride varnish |
559 |
559 |
$9K |
| D2740 |
Crown - porcelain/ceramic |
15 |
12 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
39 |
26 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
41 |
$4K |
| D4910 |
|
43 |
43 |
$3K |
| D9910 |
|
55 |
54 |
$3K |
| D2160 |
|
37 |
26 |
$3K |
| D0603 |
|
112 |
112 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
12 |
$2K |
| D4342 |
|
30 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
43 |
$516.00 |
| D1999 |
|
70 |
69 |
$0.00 |