| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,740 |
4,724 |
$313K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,661 |
1,488 |
$304K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
468 |
385 |
$223K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
298 |
292 |
$138K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,819 |
5,288 |
$114K |
| D0274 |
Bitewings - four radiographic images |
4,209 |
4,185 |
$90K |
| D9430 |
|
2,470 |
2,331 |
$79K |
| D0330 |
Panoramic radiographic image |
2,381 |
2,373 |
$71K |
| D7230 |
|
370 |
222 |
$70K |
| D7240 |
Removal of impacted tooth - completely bony |
253 |
109 |
$58K |
| D3320 |
|
141 |
135 |
$52K |
| D0340 |
|
1,009 |
1,009 |
$50K |
| D2954 |
|
364 |
301 |
$38K |
| D1120 |
Prophylaxis - child |
426 |
421 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
492 |
489 |
$17K |
| D3310 |
|
50 |
39 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
261 |
118 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
200 |
195 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
431 |
426 |
$8K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
24 |
12 |
$8K |
| D1310 |
|
143 |
141 |
$6K |
| D7220 |
|
21 |
13 |
$3K |
| D9993 |
|
45 |
45 |
$3K |
| D0603 |
|
143 |
141 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
146 |
146 |
$2K |
| D9222 |
|
12 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$132.00 |
| D0270 |
|
24 |
24 |
$45.00 |
| D0350 |
|
30 |
29 |
$0.00 |