| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,825 |
5,628 |
$141K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,046 |
1,554 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
6,460 |
6,191 |
$98K |
| D9430 |
|
5,467 |
5,135 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,760 |
1,992 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,650 |
1,835 |
$58K |
| D1120 |
Prophylaxis - child |
4,219 |
4,108 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,861 |
8,343 |
$53K |
| D1206 |
Topical application of fluoride varnish |
5,348 |
5,227 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
3,193 |
3,090 |
$49K |
| D1110 |
Prophylaxis - adult |
1,851 |
1,767 |
$47K |
| D4341 |
|
446 |
202 |
$28K |
| D0274 |
Bitewings - four radiographic images |
4,559 |
4,418 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,336 |
459 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
7,262 |
6,807 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
111 |
101 |
$23K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
37 |
32 |
$17K |
| D1351 |
Sealant - per tooth |
748 |
305 |
$5K |
| D0272 |
Bitewings - two radiographic images |
1,203 |
1,168 |
$5K |
| D0270 |
|
2,476 |
2,286 |
$4K |
| D1310 |
|
1,865 |
1,752 |
$3K |
| D2330 |
|
41 |
25 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
71 |
71 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
36 |
36 |
$2K |
| D3320 |
|
32 |
28 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
54 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
44 |
43 |
$629.00 |
| D9993 |
|
1,703 |
1,638 |
$390.00 |
| D9995 |
|
31 |
29 |
$350.00 |
| D0601 |
|
610 |
568 |
$269.00 |
| D9110 |
|
942 |
824 |
$260.00 |
| D0140 |
Limited oral evaluation - problem focused |
72 |
70 |
$245.00 |
| D0602 |
|
38 |
38 |
$126.00 |
| D1999 |
|
2,652 |
2,378 |
$50.00 |
| D0603 |
|
419 |
398 |
$15.00 |
| D2950 |
|
286 |
209 |
$0.00 |
| D1330 |
|
10,324 |
9,744 |
$0.00 |
| D0273 |
|
14 |
14 |
$0.00 |