| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,256 |
9,234 |
$584K |
| D0120 |
Periodic oral evaluation - established patient |
9,626 |
9,585 |
$490K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,100 |
1,408 |
$364K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,898 |
2,493 |
$328K |
| D1120 |
Prophylaxis - child |
8,595 |
8,553 |
$319K |
| D0210 |
Intraoral - complete series of radiographic images |
6,724 |
6,707 |
$316K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,326 |
12,880 |
$285K |
| D1110 |
Prophylaxis - adult |
3,463 |
3,457 |
$279K |
| D0274 |
Bitewings - four radiographic images |
8,575 |
8,474 |
$179K |
| D1351 |
Sealant - per tooth |
6,494 |
1,704 |
$162K |
| D8670 |
Periodic orthodontic treatment visit |
558 |
558 |
$152K |
| D4341 |
|
1,978 |
801 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,868 |
1,044 |
$125K |
| D1206 |
Topical application of fluoride varnish |
6,658 |
6,620 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,554 |
879 |
$84K |
| D2160 |
|
977 |
644 |
$78K |
| D2140 |
|
1,365 |
822 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,251 |
5,238 |
$52K |
| D0350 |
|
5,352 |
2,700 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,558 |
1,370 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
616 |
232 |
$35K |
| D2330 |
|
359 |
197 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,280 |
2,264 |
$27K |
| D1310 |
|
518 |
518 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
461 |
440 |
$18K |
| D9993 |
|
159 |
159 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
19 |
12 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
55 |
40 |
$4K |
| D9910 |
|
148 |
145 |
$4K |
| D4910 |
|
55 |
55 |
$4K |
| D0330 |
Panoramic radiographic image |
183 |
180 |
$4K |
| D4342 |
|
62 |
25 |
$3K |
| D0603 |
|
168 |
168 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
13 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
46 |
45 |
$494.00 |
| D0602 |
|
24 |
24 |
$255.00 |
| D0601 |
|
13 |
13 |
$195.00 |
| D4381 |
|
221 |
41 |
$0.00 |
| D1330 |
|
2,834 |
2,811 |
$0.00 |
| D4346 |
|
45 |
39 |
$0.00 |