| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,158 |
3,154 |
$207K |
| D0120 |
Periodic oral evaluation - established patient |
2,563 |
2,548 |
$175K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,478 |
1,343 |
$164K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,753 |
1,345 |
$148K |
| D1120 |
Prophylaxis - child |
3,287 |
3,269 |
$146K |
| D1110 |
Prophylaxis - adult |
1,619 |
1,614 |
$142K |
| D2740 |
Crown - porcelain/ceramic |
283 |
212 |
$133K |
| D0210 |
Intraoral - complete series of radiographic images |
2,569 |
2,562 |
$122K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,822 |
3,077 |
$71K |
| D1206 |
Topical application of fluoride varnish |
3,685 |
3,667 |
$65K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
135 |
122 |
$62K |
| D0350 |
|
4,688 |
2,516 |
$46K |
| D1310 |
|
747 |
743 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,509 |
1,502 |
$32K |
| D9430 |
|
990 |
947 |
$32K |
| D0330 |
Panoramic radiographic image |
1,034 |
1,030 |
$31K |
| D4341 |
|
429 |
137 |
$30K |
| D1351 |
Sealant - per tooth |
647 |
199 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
412 |
131 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
160 |
71 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,349 |
1,347 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
117 |
54 |
$12K |
| D9993 |
|
171 |
170 |
$11K |
| D0603 |
|
722 |
717 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
88 |
49 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
247 |
236 |
$10K |
| D0272 |
Bitewings - two radiographic images |
648 |
642 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
98 |
66 |
$7K |
| D4910 |
|
66 |
66 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
341 |
336 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
67 |
67 |
$2K |
| D2335 |
|
19 |
12 |
$2K |
| D2331 |
|
17 |
13 |
$1K |
| D2330 |
|
17 |
13 |
$1K |
| D1354 |
|
36 |
36 |
$1K |