| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,742 |
9,461 |
$245K |
| D0210 |
Intraoral - complete series of radiographic images |
4,755 |
4,151 |
$210K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,140 |
2,111 |
$188K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,508 |
1,346 |
$154K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,744 |
436 |
$134K |
| D1110 |
Prophylaxis - adult |
4,235 |
3,724 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
4,743 |
4,259 |
$95K |
| D0330 |
Panoramic radiographic image |
1,854 |
1,609 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
4,961 |
4,517 |
$70K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
841 |
182 |
$63K |
| D1120 |
Prophylaxis - child |
3,799 |
3,353 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,779 |
426 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,168 |
3,607 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,965 |
2,685 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
389 |
260 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
3,933 |
3,537 |
$17K |
| D9243 |
|
327 |
104 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,126 |
1,044 |
$14K |
| D2335 |
|
131 |
48 |
$11K |
| D9239 |
|
110 |
106 |
$11K |
| D5110 |
|
30 |
25 |
$9K |
| D2332 |
|
126 |
64 |
$8K |
| D0272 |
Bitewings - two radiographic images |
881 |
791 |
$8K |
| D2933 |
|
62 |
12 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
87 |
29 |
$4K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
79 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
492 |
374 |
$3K |
| D1351 |
Sealant - per tooth |
122 |
26 |
$2K |
| D9610 |
|
97 |
95 |
$2K |
| D4910 |
|
43 |
39 |
$1K |
| D9222 |
|
17 |
12 |
$1K |
| D2394 |
|
31 |
12 |
$1K |
| D0431 |
|
516 |
497 |
$0.00 |
| D9612 |
|
20 |
12 |
$0.00 |