| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,122 |
6,083 |
$363K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,451 |
1,201 |
$287K |
| D0120 |
Periodic oral evaluation - established patient |
5,342 |
5,287 |
$225K |
| D0210 |
Intraoral - complete series of radiographic images |
4,347 |
4,325 |
$181K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,602 |
8,417 |
$159K |
| D1120 |
Prophylaxis - child |
3,935 |
3,908 |
$130K |
| D0274 |
Bitewings - four radiographic images |
5,500 |
5,465 |
$96K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
131 |
123 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,665 |
3,645 |
$44K |
| D4341 |
|
564 |
148 |
$34K |
| D1351 |
Sealant - per tooth |
1,389 |
294 |
$33K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
245 |
55 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
503 |
192 |
$28K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
215 |
58 |
$21K |
| D2740 |
Crown - porcelain/ceramic |
35 |
29 |
$17K |
| D0350 |
|
1,468 |
569 |
$15K |
| D9430 |
|
487 |
469 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,230 |
1,225 |
$13K |
| D0330 |
Panoramic radiographic image |
1,277 |
1,269 |
$12K |
| D1110 |
Prophylaxis - adult |
133 |
133 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
150 |
57 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
126 |
54 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
390 |
385 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
96 |
93 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
24 |
$2K |
| D1310 |
|
40 |
40 |
$2K |
| D9993 |
|
28 |
28 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
41 |
$1K |
| D1320 |
|
52 |
52 |
$730.00 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$298.00 |
| D8670 |
Periodic orthodontic treatment visit |
166 |
144 |
$0.00 |
| D1330 |
|
27 |
27 |
$0.00 |