| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,729 |
6,699 |
$329K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,469 |
1,594 |
$288K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,701 |
3,686 |
$226K |
| D1120 |
Prophylaxis - child |
6,142 |
6,113 |
$213K |
| D0230 |
Intraoral - periapical each additional radiographic image |
45,563 |
9,897 |
$191K |
| D4341 |
|
2,706 |
712 |
$170K |
| D2140 |
|
2,766 |
1,411 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,377 |
1,093 |
$135K |
| D0210 |
Intraoral - complete series of radiographic images |
2,821 |
2,810 |
$133K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,782 |
991 |
$117K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
220 |
150 |
$103K |
| D1351 |
Sealant - per tooth |
2,897 |
730 |
$73K |
| D0272 |
Bitewings - two radiographic images |
6,245 |
6,205 |
$72K |
| D1206 |
Topical application of fluoride varnish |
4,237 |
4,220 |
$43K |
| D9993 |
|
449 |
449 |
$28K |
| D1310 |
|
585 |
585 |
$27K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
54 |
46 |
$25K |
| D2954 |
|
171 |
122 |
$18K |
| D4910 |
|
116 |
115 |
$9K |
| D1110 |
Prophylaxis - adult |
105 |
105 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
386 |
386 |
$5K |
| D0601 |
|
293 |
293 |
$4K |
| D3320 |
|
12 |
12 |
$4K |
| D4342 |
|
80 |
27 |
$3K |
| D2332 |
|
24 |
14 |
$2K |
| D9430 |
|
53 |
53 |
$2K |
| D2331 |
|
19 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$1K |