| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,583 |
11,182 |
$441K |
| D4341 |
|
5,002 |
2,031 |
$312K |
| D0210 |
Intraoral - complete series of radiographic images |
6,635 |
6,466 |
$281K |
| D1120 |
Prophylaxis - child |
6,705 |
6,521 |
$190K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,309 |
10,938 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
7,428 |
6,637 |
$103K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,732 |
687 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,943 |
1,365 |
$87K |
| D0274 |
Bitewings - four radiographic images |
6,331 |
5,846 |
$71K |
| D1206 |
Topical application of fluoride varnish |
5,771 |
5,563 |
$68K |
| D0330 |
Panoramic radiographic image |
2,622 |
2,544 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,310 |
930 |
$55K |
| D8670 |
Periodic orthodontic treatment visit |
447 |
416 |
$51K |
| D4910 |
|
662 |
662 |
$48K |
| D1110 |
Prophylaxis - adult |
1,622 |
1,493 |
$46K |
| D9430 |
|
1,661 |
1,581 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,338 |
1,256 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,473 |
3,248 |
$26K |
| D2740 |
Crown - porcelain/ceramic |
31 |
25 |
$16K |
| D1310 |
|
337 |
337 |
$14K |
| D1351 |
Sealant - per tooth |
2,206 |
572 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
494 |
315 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,013 |
1,895 |
$9K |
| D5214 |
|
14 |
14 |
$8K |
| D4342 |
|
190 |
87 |
$8K |
| D0272 |
Bitewings - two radiographic images |
1,181 |
1,165 |
$7K |
| D2160 |
|
54 |
41 |
$4K |
| D0350 |
|
343 |
187 |
$4K |
| D0470 |
|
25 |
25 |
$2K |
| D2140 |
|
137 |
111 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
624 |
327 |
$2K |
| D2331 |
|
42 |
28 |
$2K |
| D0340 |
|
25 |
25 |
$2K |
| D0603 |
|
45 |
45 |
$546.00 |
| D0270 |
|
382 |
321 |
$247.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
524 |
461 |
$200.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
83 |
77 |
$0.00 |
| D4921 |
|
1,297 |
477 |
$0.00 |
| D1999 |
|
56 |
55 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
670 |
149 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$0.00 |
| D9993 |
|
59 |
59 |
$0.00 |
| D2751 |
Crown - porcelain fused to predominantly base metal |
41 |
25 |
$0.00 |
| D3221 |
|
25 |
14 |
$0.00 |
| D9243 |
|
373 |
51 |
$0.00 |
| D2332 |
|
47 |
28 |
$0.00 |
| D9310 |
|
700 |
697 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
212 |
85 |
$0.00 |
| D1330 |
|
2,336 |
2,206 |
$0.00 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
208 |
37 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
61 |
59 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
28 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |
| D5410 |
|
33 |
15 |
$0.00 |