| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,237 |
10,217 |
$653K |
| D0210 |
Intraoral - complete series of radiographic images |
9,040 |
9,023 |
$428K |
| D0120 |
Periodic oral evaluation - established patient |
6,184 |
6,161 |
$318K |
| D1110 |
Prophylaxis - adult |
3,287 |
3,281 |
$277K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,964 |
872 |
$232K |
| D4341 |
|
3,257 |
1,234 |
$224K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,174 |
8,616 |
$177K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,401 |
1,416 |
$130K |
| D0274 |
Bitewings - four radiographic images |
6,004 |
5,959 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,806 |
1,221 |
$120K |
| D1120 |
Prophylaxis - child |
2,741 |
2,741 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,373 |
4,372 |
$50K |
| D0350 |
|
5,041 |
2,517 |
$48K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
694 |
438 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,378 |
2,369 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
972 |
967 |
$34K |
| D4910 |
|
437 |
437 |
$30K |
| D0330 |
Panoramic radiographic image |
957 |
954 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
300 |
89 |
$17K |
| D4342 |
|
401 |
169 |
$17K |
| D2740 |
Crown - porcelain/ceramic |
21 |
17 |
$11K |
| D2140 |
|
129 |
80 |
$7K |
| D9910 |
|
120 |
119 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$6K |
| D9430 |
|
166 |
156 |
$5K |
| D2160 |
|
53 |
39 |
$4K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
14 |
12 |
$4K |
| D2330 |
|
38 |
29 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
24 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
53 |
49 |
$2K |
| D0272 |
Bitewings - two radiographic images |
162 |
162 |
$2K |
| D2331 |
|
21 |
12 |
$2K |
| D9222 |
|
12 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
74 |
14 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
80 |
$960.00 |
| D1999 |
|
1,021 |
940 |
$564.50 |
| D1330 |
|
178 |
178 |
$0.00 |