| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,229 |
10,984 |
$739K |
| D1110 |
Prophylaxis - adult |
6,919 |
6,759 |
$602K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,389 |
4,315 |
$557K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,867 |
1,699 |
$454K |
| D0210 |
Intraoral - complete series of radiographic images |
8,216 |
8,023 |
$388K |
| D0120 |
Periodic oral evaluation - established patient |
5,492 |
5,415 |
$377K |
| D1120 |
Prophylaxis - child |
6,943 |
6,827 |
$305K |
| D4341 |
|
4,260 |
1,186 |
$297K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,715 |
2,343 |
$293K |
| D2740 |
Crown - porcelain/ceramic |
568 |
447 |
$270K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,761 |
2,331 |
$257K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,086 |
1,160 |
$233K |
| D1206 |
Topical application of fluoride varnish |
13,955 |
13,678 |
$232K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
426 |
403 |
$197K |
| D0350 |
|
14,079 |
4,873 |
$136K |
| D1351 |
Sealant - per tooth |
2,846 |
699 |
$97K |
| D9430 |
|
2,809 |
2,729 |
$90K |
| D2330 |
|
1,095 |
487 |
$83K |
| D0274 |
Bitewings - four radiographic images |
4,138 |
4,089 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,989 |
7,758 |
$71K |
| D3320 |
|
141 |
122 |
$52K |
| D4910 |
|
623 |
623 |
$47K |
| D2335 |
|
385 |
183 |
$45K |
| D0330 |
Panoramic radiographic image |
1,108 |
1,107 |
$31K |
| D2332 |
|
364 |
191 |
$30K |
| D2394 |
|
353 |
259 |
$29K |
| D3310 |
|
93 |
58 |
$28K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
229 |
47 |
$27K |
| D1310 |
|
503 |
495 |
$22K |
| D4342 |
|
441 |
143 |
$18K |
| D2331 |
|
219 |
127 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,420 |
1,398 |
$17K |
| D2954 |
|
145 |
113 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
152 |
152 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
90 |
29 |
$9K |
| D5110 |
|
14 |
14 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
803 |
788 |
$9K |
| D5211 |
|
13 |
13 |
$5K |
| D0603 |
|
180 |
180 |
$3K |
| D9248 |
|
59 |
59 |
$2K |
| D3221 |
|
14 |
13 |
$882.00 |
| D0601 |
|
41 |
41 |
$570.00 |
| D0270 |
|
94 |
90 |
$465.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
27 |
27 |
$0.00 |