| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,843 |
10,808 |
$680K |
| D0120 |
Periodic oral evaluation - established patient |
9,868 |
9,831 |
$536K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,686 |
2,067 |
$435K |
| D1110 |
Prophylaxis - adult |
4,348 |
4,335 |
$371K |
| D1120 |
Prophylaxis - child |
9,000 |
8,975 |
$349K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,055 |
14,817 |
$289K |
| D0210 |
Intraoral - complete series of radiographic images |
6,104 |
6,075 |
$286K |
| D1351 |
Sealant - per tooth |
9,188 |
1,586 |
$244K |
| D0274 |
Bitewings - four radiographic images |
8,564 |
8,538 |
$180K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,112 |
13,073 |
$168K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,461 |
895 |
$140K |
| D8670 |
Periodic orthodontic treatment visit |
431 |
429 |
$119K |
| D0330 |
Panoramic radiographic image |
4,296 |
4,277 |
$116K |
| D4341 |
|
1,688 |
702 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,099 |
759 |
$73K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
646 |
408 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
836 |
827 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
495 |
350 |
$27K |
| D4910 |
|
262 |
262 |
$18K |
| D2740 |
Crown - porcelain/ceramic |
38 |
27 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,062 |
1,058 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
297 |
267 |
$12K |
| D9910 |
|
151 |
151 |
$8K |
| D1206 |
Topical application of fluoride varnish |
357 |
357 |
$6K |
| D4342 |
|
105 |
37 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
211 |
211 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
12 |
$2K |
| D1310 |
|
390 |
385 |
$1K |
| D2140 |
|
25 |
14 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
15 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$708.00 |
| D9430 |
|
13 |
13 |
$416.00 |
| D0602 |
|
212 |
212 |
$405.00 |
| D0350 |
|
22 |
14 |
$211.20 |