| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,215 |
9,073 |
$478K |
| D1120 |
Prophylaxis - child |
9,519 |
9,361 |
$352K |
| D0230 |
Intraoral - periapical each additional radiographic image |
62,865 |
11,926 |
$248K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
499 |
384 |
$236K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,892 |
2,822 |
$171K |
| D1351 |
Sealant - per tooth |
5,030 |
1,232 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,296 |
9,148 |
$114K |
| D0272 |
Bitewings - two radiographic images |
9,326 |
9,182 |
$106K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,397 |
839 |
$92K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
791 |
395 |
$91K |
| D1110 |
Prophylaxis - adult |
890 |
878 |
$72K |
| D9430 |
|
2,050 |
1,995 |
$62K |
| D1310 |
|
1,373 |
1,372 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
1,365 |
1,330 |
$60K |
| D9993 |
|
767 |
766 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
405 |
239 |
$27K |
| D0330 |
Panoramic radiographic image |
894 |
877 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
601 |
574 |
$23K |
| D2160 |
|
261 |
190 |
$20K |
| D2140 |
|
335 |
251 |
$18K |
| D0603 |
|
1,014 |
1,013 |
$15K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
25 |
24 |
$12K |
| D2952 |
|
101 |
84 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
181 |
122 |
$10K |
| D4341 |
|
129 |
41 |
$9K |
| D7240 |
Removal of impacted tooth - completely bony |
29 |
12 |
$7K |
| D0274 |
Bitewings - four radiographic images |
309 |
295 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
434 |
422 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
28 |
14 |
$3K |
| D8670 |
Periodic orthodontic treatment visit |
14 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
24 |
$2K |
| D2330 |
|
20 |
12 |
$2K |
| D0602 |
|
99 |
99 |
$1K |
| D3221 |
|
18 |
13 |
$819.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$525.00 |
| D0270 |
|
97 |
97 |
$462.50 |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
15 |
$392.00 |
| D0350 |
|
36 |
25 |
$259.20 |