| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,631 |
10,608 |
$908K |
| D0120 |
Periodic oral evaluation - established patient |
14,557 |
14,514 |
$846K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,600 |
9,572 |
$589K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,056 |
2,221 |
$477K |
| D1120 |
Prophylaxis - child |
12,010 |
11,970 |
$455K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
835 |
741 |
$393K |
| D0210 |
Intraoral - complete series of radiographic images |
7,008 |
6,987 |
$328K |
| D9430 |
|
9,928 |
9,182 |
$313K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,586 |
22,520 |
$296K |
| D1351 |
Sealant - per tooth |
10,382 |
2,593 |
$281K |
| D0274 |
Bitewings - four radiographic images |
11,705 |
11,668 |
$250K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,719 |
1,337 |
$211K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
399 |
394 |
$185K |
| D0330 |
Panoramic radiographic image |
4,978 |
4,948 |
$145K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,152 |
16,129 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
7,267 |
6,880 |
$86K |
| D3221 |
|
1,193 |
1,130 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
773 |
480 |
$50K |
| D3320 |
|
109 |
101 |
$40K |
| D0272 |
Bitewings - two radiographic images |
3,380 |
3,368 |
$40K |
| D0145 |
Oral evaluation for a patient under three years of age |
226 |
226 |
$9K |
| D5130 |
|
14 |
14 |
$9K |
| D2330 |
|
109 |
66 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
53 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
37 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$455.00 |
| D0350 |
|
24 |
16 |
$201.60 |