| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,532 |
16,485 |
$860K |
| D0230 |
Intraoral - periapical each additional radiographic image |
182,164 |
24,567 |
$759K |
| D1120 |
Prophylaxis - child |
15,648 |
15,600 |
$581K |
| D7240 |
Removal of impacted tooth - completely bony |
2,371 |
963 |
$548K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,182 |
4,823 |
$546K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,085 |
804 |
$516K |
| D2140 |
|
7,076 |
4,165 |
$383K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,766 |
4,741 |
$303K |
| D1351 |
Sealant - per tooth |
11,337 |
3,803 |
$296K |
| D0272 |
Bitewings - two radiographic images |
19,370 |
19,306 |
$228K |
| D1110 |
Prophylaxis - adult |
2,117 |
2,111 |
$186K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,961 |
15,909 |
$169K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,417 |
605 |
$165K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
351 |
321 |
$162K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,633 |
698 |
$162K |
| D2954 |
|
1,386 |
1,079 |
$145K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,531 |
1,421 |
$145K |
| D4341 |
|
1,356 |
369 |
$95K |
| D9430 |
|
2,403 |
2,296 |
$77K |
| D2160 |
|
649 |
481 |
$51K |
| D0350 |
|
5,119 |
2,083 |
$45K |
| D4342 |
|
1,029 |
304 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
240 |
123 |
$29K |
| D4910 |
|
178 |
178 |
$14K |
| D1320 |
|
744 |
741 |
$9K |
| D1310 |
|
598 |
598 |
$5K |
| D2330 |
|
63 |
40 |
$5K |
| D3320 |
|
13 |
12 |
$5K |
| D2931 |
|
30 |
27 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
228 |
227 |
$3K |
| D0601 |
|
482 |
482 |
$1K |
| D0602 |
|
158 |
158 |
$285.00 |
| D0603 |
|
80 |
80 |
$135.00 |
| D1330 |
|
830 |
830 |
$0.00 |