| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,672 |
11,634 |
$734K |
| D0120 |
Periodic oral evaluation - established patient |
11,780 |
11,735 |
$605K |
| D0210 |
Intraoral - complete series of radiographic images |
8,685 |
8,660 |
$404K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,997 |
16,117 |
$334K |
| D1120 |
Prophylaxis - child |
7,863 |
7,839 |
$290K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,575 |
2,209 |
$261K |
| D1110 |
Prophylaxis - adult |
3,121 |
3,107 |
$252K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,072 |
1,483 |
$245K |
| D0274 |
Bitewings - four radiographic images |
11,146 |
10,943 |
$225K |
| D4341 |
|
2,834 |
1,128 |
$189K |
| D8670 |
Periodic orthodontic treatment visit |
588 |
588 |
$160K |
| D1351 |
Sealant - per tooth |
5,119 |
1,377 |
$129K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,977 |
1,391 |
$107K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,491 |
8,459 |
$98K |
| D4342 |
|
2,127 |
875 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,271 |
915 |
$85K |
| D2140 |
|
1,243 |
730 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
959 |
557 |
$63K |
| D1310 |
|
931 |
930 |
$42K |
| D0350 |
|
4,375 |
2,482 |
$39K |
| D9993 |
|
595 |
595 |
$38K |
| D9910 |
|
666 |
639 |
$35K |
| D1206 |
Topical application of fluoride varnish |
2,498 |
2,496 |
$34K |
| D4910 |
|
445 |
441 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
781 |
779 |
$27K |
| D0330 |
Panoramic radiographic image |
1,535 |
1,526 |
$24K |
| D0272 |
Bitewings - two radiographic images |
2,121 |
2,095 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
405 |
366 |
$15K |
| D2740 |
Crown - porcelain/ceramic |
17 |
12 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
44 |
25 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
47 |
24 |
$5K |
| D0603 |
|
211 |
210 |
$3K |
| D0602 |
|
145 |
145 |
$2K |
| D2330 |
|
23 |
13 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$1K |
| D2160 |
|
17 |
12 |
$1K |
| D0270 |
|
253 |
251 |
$1K |
| D9430 |
|
32 |
32 |
$992.00 |
| D1352 |
|
48 |
27 |
$770.00 |
| D0601 |
|
37 |
37 |
$506.25 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
41 |
$493.60 |
| D1999 |
|
1,143 |
1,141 |
$356.50 |