| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
21,484 |
21,438 |
$1.39M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,724 |
7,544 |
$1.18M |
| D0120 |
Periodic oral evaluation - established patient |
27,334 |
27,281 |
$1.10M |
| D7140 |
Extraction, erupted tooth or exposed root |
9,868 |
5,471 |
$869K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,121 |
6,318 |
$785K |
| D1120 |
Prophylaxis - child |
15,995 |
15,961 |
$638K |
| D1206 |
Topical application of fluoride varnish |
19,815 |
19,777 |
$491K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,238 |
2,870 |
$455K |
| D0140 |
Limited oral evaluation - problem focused |
5,633 |
5,532 |
$450K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,126 |
7,105 |
$449K |
| D0210 |
Intraoral - complete series of radiographic images |
6,890 |
6,855 |
$348K |
| D2331 |
|
3,138 |
2,427 |
$326K |
| D5110 |
|
338 |
337 |
$275K |
| D0274 |
Bitewings - four radiographic images |
9,991 |
9,968 |
$244K |
| D1351 |
Sealant - per tooth |
7,974 |
2,508 |
$219K |
| D2330 |
|
2,268 |
1,790 |
$201K |
| D2335 |
|
1,319 |
1,067 |
$183K |
| D2332 |
|
1,377 |
1,147 |
$165K |
| D2740 |
Crown - porcelain/ceramic |
259 |
221 |
$155K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
839 |
545 |
$151K |
| D0272 |
Bitewings - two radiographic images |
4,575 |
4,561 |
$100K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
931 |
749 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
8,155 |
8,020 |
$79K |
| D0240 |
|
3,537 |
1,899 |
$72K |
| D2394 |
|
385 |
356 |
$60K |
| D5120 |
|
156 |
156 |
$60K |
| D2140 |
|
666 |
523 |
$55K |
| D4355 |
|
412 |
409 |
$48K |
| D2160 |
|
330 |
293 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
210 |
184 |
$27K |
| D2950 |
|
169 |
155 |
$26K |
| D0145 |
Oral evaluation for a patient under three years of age |
599 |
598 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,671 |
1,715 |
$16K |
| D9310 |
|
142 |
142 |
$11K |
| D0330 |
Panoramic radiographic image |
285 |
283 |
$6K |
| D1354 |
|
161 |
67 |
$5K |
| D4910 |
|
63 |
63 |
$5K |
| D4341 |
|
26 |
14 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
29 |
24 |
$3K |
| D0191 |
|
204 |
204 |
$3K |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
24 |
24 |
$0.00 |