| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,022 |
12,928 |
$627K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,366 |
7,320 |
$429K |
| D1120 |
Prophylaxis - child |
11,580 |
11,447 |
$404K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,912 |
1,514 |
$336K |
| D0230 |
Intraoral - periapical each additional radiographic image |
81,544 |
16,232 |
$323K |
| D0210 |
Intraoral - complete series of radiographic images |
6,026 |
5,978 |
$250K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,602 |
2,266 |
$223K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
426 |
395 |
$197K |
| D1110 |
Prophylaxis - adult |
2,250 |
2,226 |
$169K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,415 |
506 |
$162K |
| D1206 |
Topical application of fluoride varnish |
13,087 |
12,969 |
$157K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,374 |
502 |
$133K |
| D1351 |
Sealant - per tooth |
4,708 |
1,106 |
$130K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,061 |
974 |
$115K |
| D0272 |
Bitewings - two radiographic images |
10,291 |
10,174 |
$108K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,669 |
878 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,848 |
1,246 |
$90K |
| D8670 |
Periodic orthodontic treatment visit |
301 |
298 |
$80K |
| D9430 |
|
2,066 |
2,023 |
$60K |
| D4341 |
|
906 |
257 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,520 |
1,491 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,910 |
2,900 |
$53K |
| D2140 |
|
712 |
447 |
$36K |
| D0330 |
Panoramic radiographic image |
1,193 |
1,180 |
$30K |
| D2160 |
|
219 |
156 |
$17K |
| D3320 |
|
44 |
36 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,476 |
1,449 |
$16K |
| D7240 |
Removal of impacted tooth - completely bony |
62 |
27 |
$14K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
29 |
24 |
$14K |
| D7230 |
|
63 |
38 |
$12K |
| D1310 |
|
251 |
251 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
90 |
$9K |
| D0350 |
|
461 |
294 |
$4K |
| D0603 |
|
262 |
261 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
79 |
79 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
60 |
$2K |
| D4910 |
|
13 |
13 |
$946.00 |
| D0270 |
|
53 |
53 |
$235.00 |
| D1999 |
|
351 |
338 |
$40.00 |
| D1330 |
|
4,543 |
4,480 |
$0.00 |