| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,282 |
4,266 |
$276K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,036 |
6,536 |
$155K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
316 |
287 |
$146K |
| D1110 |
Prophylaxis - adult |
1,009 |
1,004 |
$82K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
519 |
343 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
4,667 |
4,327 |
$55K |
| D0272 |
Bitewings - two radiographic images |
4,337 |
4,321 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
676 |
673 |
$43K |
| D9430 |
|
1,312 |
1,239 |
$42K |
| D9110 |
|
532 |
489 |
$33K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
51 |
40 |
$24K |
| D4341 |
|
328 |
87 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,203 |
1,201 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
236 |
83 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
178 |
91 |
$12K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
80 |
29 |
$11K |
| D0350 |
|
634 |
330 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
181 |
181 |
$9K |
| D0330 |
Panoramic radiographic image |
248 |
248 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
58 |
$6K |
| D2160 |
|
73 |
53 |
$6K |
| D9222 |
|
29 |
29 |
$4K |
| D2954 |
|
33 |
26 |
$3K |
| D1120 |
Prophylaxis - child |
98 |
96 |
$3K |
| D1206 |
Topical application of fluoride varnish |
256 |
249 |
$2K |
| D4910 |
|
13 |
13 |
$1K |