| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,811 |
3,802 |
$251K |
| D1120 |
Prophylaxis - child |
3,154 |
3,148 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
1,793 |
1,789 |
$137K |
| D0210 |
Intraoral - complete series of radiographic images |
2,806 |
2,800 |
$132K |
| D1351 |
Sealant - per tooth |
3,534 |
894 |
$113K |
| D2140 |
|
1,661 |
791 |
$90K |
| D1110 |
Prophylaxis - adult |
1,005 |
1,001 |
$85K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,234 |
638 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,923 |
3,804 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,641 |
4,632 |
$71K |
| D1320 |
|
2,783 |
2,776 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,883 |
1,881 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
334 |
187 |
$39K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
81 |
76 |
$38K |
| D4341 |
|
505 |
143 |
$35K |
| D4910 |
|
321 |
321 |
$24K |
| D1310 |
|
494 |
491 |
$21K |
| D0350 |
|
1,057 |
906 |
$19K |
| D9430 |
|
457 |
446 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
940 |
930 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
188 |
91 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
13 |
$9K |
| D2160 |
|
57 |
40 |
$4K |
| D9993 |
|
55 |
55 |
$4K |
| D7111 |
|
52 |
26 |
$3K |
| D0603 |
|
183 |
183 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
31 |
$2K |
| D0272 |
Bitewings - two radiographic images |
148 |
148 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
47 |
47 |
$2K |
| D2954 |
|
14 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
48 |
48 |
$1K |
| D0602 |
|
14 |
14 |
$195.00 |