| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,954 |
2,909 |
$175K |
| D0210 |
Intraoral - complete series of radiographic images |
2,280 |
2,252 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
1,564 |
1,552 |
$94K |
| D1120 |
Prophylaxis - child |
2,426 |
2,401 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,961 |
3,765 |
$76K |
| D9430 |
|
2,331 |
2,262 |
$74K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
648 |
307 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,106 |
607 |
$71K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
129 |
113 |
$60K |
| D1110 |
Prophylaxis - adult |
351 |
351 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,686 |
1,671 |
$27K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
50 |
43 |
$24K |
| D0330 |
Panoramic radiographic image |
1,468 |
1,459 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,074 |
1,068 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
394 |
217 |
$19K |
| D4341 |
|
254 |
71 |
$15K |
| D1206 |
Topical application of fluoride varnish |
1,161 |
1,155 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
250 |
117 |
$13K |
| D8670 |
Periodic orthodontic treatment visit |
39 |
39 |
$11K |
| D0272 |
Bitewings - two radiographic images |
906 |
873 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
44 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
85 |
35 |
$5K |
| D7230 |
|
25 |
12 |
$5K |
| D1351 |
Sealant - per tooth |
165 |
42 |
$5K |
| D0350 |
|
320 |
132 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
257 |
252 |
$3K |
| D2140 |
|
42 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
49 |
48 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
41 |
38 |
$1K |
| D2160 |
|
13 |
12 |
$1K |
| D4910 |
|
12 |
12 |
$847.00 |
| D1310 |
|
32 |
32 |
$770.50 |
| D0603 |
|
29 |
29 |
$251.25 |
| D1999 |
|
66 |
65 |
$20.00 |
| D1330 |
|
1,039 |
1,030 |
$0.00 |