| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,151 |
16,091 |
$895K |
| D1120 |
Prophylaxis - child |
13,181 |
13,141 |
$503K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
934 |
887 |
$430K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,392 |
3,964 |
$428K |
| D0230 |
Intraoral - periapical each additional radiographic image |
95,128 |
17,168 |
$381K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
727 |
640 |
$341K |
| D1110 |
Prophylaxis - adult |
3,524 |
3,507 |
$302K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,463 |
4,457 |
$282K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,852 |
920 |
$220K |
| D7240 |
Removal of impacted tooth - completely bony |
878 |
347 |
$201K |
| D0210 |
Intraoral - complete series of radiographic images |
3,984 |
3,978 |
$188K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,345 |
13,305 |
$153K |
| D0274 |
Bitewings - four radiographic images |
6,441 |
6,403 |
$138K |
| D2954 |
|
1,190 |
1,060 |
$123K |
| D2140 |
|
1,997 |
1,481 |
$108K |
| D2160 |
|
1,175 |
932 |
$93K |
| D3320 |
|
255 |
236 |
$92K |
| D0272 |
Bitewings - two radiographic images |
7,855 |
7,831 |
$91K |
| D1206 |
Topical application of fluoride varnish |
2,109 |
2,097 |
$37K |
| D4341 |
|
531 |
171 |
$35K |
| D0350 |
|
3,853 |
2,887 |
$35K |
| D0330 |
Panoramic radiographic image |
1,059 |
1,058 |
$30K |
| D2931 |
|
230 |
204 |
$29K |
| D1351 |
Sealant - per tooth |
1,339 |
306 |
$29K |
| D4910 |
|
360 |
358 |
$27K |
| D7230 |
|
92 |
50 |
$17K |
| D7111 |
|
229 |
174 |
$13K |
| D2951 |
|
27 |
25 |
$3K |
| D2330 |
|
36 |
24 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
52 |
52 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
26 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
18 |
$2K |
| D9430 |
|
27 |
27 |
$864.00 |