| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,912 |
2,903 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
2,281 |
2,276 |
$122K |
| D0210 |
Intraoral - complete series of radiographic images |
2,584 |
2,573 |
$119K |
| D1110 |
Prophylaxis - adult |
1,034 |
1,033 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,185 |
499 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,043 |
612 |
$66K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
542 |
314 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,034 |
2,990 |
$60K |
| D4341 |
|
806 |
239 |
$51K |
| D1120 |
Prophylaxis - child |
1,316 |
1,314 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,943 |
1,940 |
$41K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
68 |
47 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,443 |
2,433 |
$28K |
| D1320 |
|
1,255 |
1,253 |
$22K |
| D2140 |
|
319 |
203 |
$17K |
| D4910 |
|
184 |
184 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
30 |
30 |
$14K |
| D2954 |
|
54 |
43 |
$6K |
| D9430 |
|
160 |
155 |
$5K |
| D2160 |
|
63 |
42 |
$4K |
| D1351 |
Sealant - per tooth |
96 |
22 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
43 |
$3K |
| D2330 |
|
40 |
26 |
$3K |
| D0330 |
Panoramic radiographic image |
60 |
59 |
$2K |
| D0340 |
|
17 |
17 |
$850.00 |
| D0272 |
Bitewings - two radiographic images |
51 |
51 |
$612.00 |
| D0270 |
|
80 |
77 |
$400.00 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$277.50 |