| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
40,089 |
39,534 |
$463K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,318 |
2,035 |
$403K |
| D8670 |
Periodic orthodontic treatment visit |
8,945 |
8,498 |
$337K |
| D0210 |
Intraoral - complete series of radiographic images |
11,039 |
11,027 |
$303K |
| D7140 |
Extraction, erupted tooth or exposed root |
13,254 |
5,678 |
$230K |
| D5110 |
|
1,461 |
1,427 |
$209K |
| D4346 |
|
9,746 |
9,577 |
$199K |
| D1351 |
Sealant - per tooth |
16,643 |
1,909 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,902 |
14,771 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,491 |
4,786 |
$156K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,507 |
2,624 |
$138K |
| D1110 |
Prophylaxis - adult |
13,525 |
13,312 |
$135K |
| D5120 |
|
889 |
866 |
$135K |
| D0274 |
Bitewings - four radiographic images |
31,249 |
30,588 |
$113K |
| D1120 |
Prophylaxis - child |
8,504 |
8,431 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
8,866 |
8,586 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
58,492 |
38,332 |
$83K |
| D4341 |
|
3,111 |
1,373 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
43,949 |
42,844 |
$77K |
| D4355 |
|
1,359 |
1,308 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,075 |
2,287 |
$65K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
336 |
317 |
$64K |
| D0330 |
Panoramic radiographic image |
19,193 |
18,748 |
$58K |
| D0180 |
|
5,514 |
5,480 |
$55K |
| D5214 |
|
349 |
336 |
$50K |
| D1206 |
Topical application of fluoride varnish |
10,612 |
10,577 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,141 |
11,002 |
$47K |
| D5213 |
|
278 |
272 |
$46K |
| D9911 |
|
2,405 |
1,099 |
$45K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
152 |
151 |
$43K |
| D2954 |
|
1,379 |
1,243 |
$37K |
| D8660 |
|
1,535 |
1,494 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
840 |
702 |
$30K |
| D2952 |
|
432 |
375 |
$26K |
| D2335 |
|
329 |
208 |
$19K |
| D0601 |
|
2,405 |
2,388 |
$12K |
| D2331 |
|
289 |
205 |
$9K |
| D0272 |
Bitewings - two radiographic images |
3,398 |
3,370 |
$8K |
| D0603 |
|
1,174 |
1,165 |
$6K |
| D9310 |
|
841 |
839 |
$6K |
| D7230 |
|
122 |
73 |
$5K |
| D3320 |
|
82 |
73 |
$5K |
| D2330 |
|
91 |
55 |
$3K |
| D0602 |
|
474 |
474 |
$3K |
| D2332 |
|
53 |
39 |
$2K |
| D7111 |
|
146 |
116 |
$2K |
| D7240 |
Removal of impacted tooth - completely bony |
32 |
13 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
35 |
28 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
227 |
226 |
$1K |
| D9945 |
|
45 |
41 |
$540.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
48 |
48 |
$495.00 |
| D4910 |
|
14 |
14 |
$462.00 |
| D0240 |
|
72 |
72 |
$375.00 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
26 |
26 |
$370.00 |
| D4342 |
|
19 |
12 |
$321.00 |
| D0270 |
|
344 |
288 |
$267.00 |
| D9920 |
|
15 |
14 |
$157.00 |
| D9222 |
|
25 |
25 |
$148.00 |
| D0350 |
|
36 |
36 |
$68.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
46 |
46 |
$0.00 |