| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,356 |
6,341 |
$395K |
| D0120 |
Periodic oral evaluation - established patient |
5,379 |
5,366 |
$258K |
| D0210 |
Intraoral - complete series of radiographic images |
5,260 |
5,242 |
$246K |
| D4341 |
|
3,270 |
1,287 |
$222K |
| D8670 |
Periodic orthodontic treatment visit |
617 |
616 |
$172K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,961 |
6,859 |
$152K |
| D1110 |
Prophylaxis - adult |
1,553 |
1,552 |
$128K |
| D0274 |
Bitewings - four radiographic images |
4,949 |
4,921 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,530 |
1,101 |
$102K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
221 |
211 |
$102K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
842 |
279 |
$99K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,421 |
879 |
$95K |
| D1120 |
Prophylaxis - child |
2,309 |
2,301 |
$79K |
| D4910 |
|
686 |
686 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,859 |
3,850 |
$45K |
| D2160 |
|
459 |
310 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
438 |
342 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
813 |
808 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
422 |
298 |
$23K |
| D2954 |
|
203 |
176 |
$21K |
| D0350 |
|
2,194 |
1,344 |
$20K |
| D4342 |
|
464 |
219 |
$19K |
| D1351 |
Sealant - per tooth |
663 |
174 |
$14K |
| D3320 |
|
29 |
28 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
15 |
$8K |
| D9430 |
|
199 |
195 |
$6K |
| D2140 |
|
107 |
71 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
116 |
111 |
$4K |
| D9910 |
|
61 |
61 |
$3K |
| D1206 |
Topical application of fluoride varnish |
166 |
165 |
$2K |
| D2330 |
|
21 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
60 |
60 |
$696.00 |
| D0272 |
Bitewings - two radiographic images |
44 |
44 |
$464.00 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$420.00 |
| D1330 |
|
24 |
24 |
$0.00 |