| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
17,717 |
17,697 |
$1.36M |
| D4341 |
|
19,304 |
5,396 |
$1.33M |
| D0120 |
Periodic oral evaluation - established patient |
19,758 |
19,717 |
$1.20M |
| D1110 |
Prophylaxis - adult |
12,853 |
12,821 |
$1.13M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,699 |
10,682 |
$686K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,017 |
6,311 |
$671K |
| D4342 |
|
15,741 |
4,841 |
$658K |
| D1120 |
Prophylaxis - child |
14,981 |
14,955 |
$602K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,014 |
25,475 |
$588K |
| D0210 |
Intraoral - complete series of radiographic images |
11,787 |
11,765 |
$553K |
| D0274 |
Bitewings - four radiographic images |
20,361 |
20,325 |
$436K |
| D1208 |
Topical application of fluoride, excluding varnish |
29,112 |
29,053 |
$373K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,107 |
1,877 |
$370K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,102 |
3,739 |
$331K |
| D2740 |
Crown - porcelain/ceramic |
593 |
471 |
$282K |
| D9430 |
|
7,401 |
7,093 |
$235K |
| D7240 |
Removal of impacted tooth - completely bony |
869 |
455 |
$201K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
397 |
298 |
$189K |
| D7230 |
|
676 |
435 |
$128K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,895 |
982 |
$109K |
| D1320 |
|
6,864 |
6,820 |
$104K |
| D0350 |
|
5,258 |
4,700 |
$99K |
| D1351 |
Sealant - per tooth |
3,830 |
910 |
$94K |
| D0330 |
Panoramic radiographic image |
2,532 |
2,528 |
$75K |
| D0340 |
|
1,376 |
1,371 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
3,469 |
3,429 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
511 |
328 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
419 |
343 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
874 |
871 |
$30K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
50 |
50 |
$23K |
| D0272 |
Bitewings - two radiographic images |
768 |
765 |
$9K |
| D1310 |
|
196 |
196 |
$9K |
| D2330 |
|
60 |
38 |
$5K |
| D3310 |
|
12 |
12 |
$4K |
| D9993 |
|
57 |
57 |
$3K |
| D0270 |
|
310 |
299 |
$2K |
| D2140 |
|
15 |
12 |
$819.00 |
| D0603 |
|
51 |
51 |
$735.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$560.00 |
| D1999 |
|
323 |
323 |
$46.00 |