| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,532 |
12,483 |
$807K |
| D0120 |
Periodic oral evaluation - established patient |
10,840 |
10,796 |
$700K |
| D1110 |
Prophylaxis - adult |
6,452 |
6,424 |
$564K |
| D1120 |
Prophylaxis - child |
11,780 |
11,735 |
$476K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,124 |
4,148 |
$471K |
| D0210 |
Intraoral - complete series of radiographic images |
9,652 |
9,610 |
$452K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,457 |
2,077 |
$404K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
765 |
591 |
$363K |
| D4341 |
|
4,758 |
1,271 |
$332K |
| D0230 |
Intraoral - periapical each additional radiographic image |
80,442 |
17,538 |
$331K |
| D4910 |
|
4,197 |
4,179 |
$320K |
| D9430 |
|
8,684 |
7,708 |
$276K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,599 |
19,517 |
$262K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,821 |
2,756 |
$259K |
| D1351 |
Sealant - per tooth |
6,412 |
1,664 |
$176K |
| D0274 |
Bitewings - four radiographic images |
7,974 |
7,938 |
$167K |
| D0330 |
Panoramic radiographic image |
4,537 |
4,524 |
$132K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
287 |
268 |
$132K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,558 |
1,194 |
$123K |
| D0350 |
|
11,034 |
4,423 |
$105K |
| D1310 |
|
2,140 |
2,138 |
$95K |
| D9993 |
|
1,224 |
1,224 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
5,324 |
5,125 |
$63K |
| D3320 |
|
151 |
140 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
958 |
576 |
$54K |
| D2952 |
|
474 |
375 |
$49K |
| D0272 |
Bitewings - two radiographic images |
3,198 |
3,189 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
468 |
257 |
$30K |
| D4342 |
|
618 |
188 |
$26K |
| D3221 |
|
303 |
284 |
$19K |
| D0601 |
|
1,184 |
1,181 |
$17K |
| D2330 |
|
210 |
142 |
$16K |
| D2140 |
|
164 |
84 |
$8K |
| D0603 |
|
325 |
325 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
76 |
76 |
$4K |
| D2160 |
|
19 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
37 |
37 |
$508.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
20 |
17 |
$0.00 |