| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,505 |
9,354 |
$519K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,476 |
1,030 |
$448K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,163 |
3,169 |
$448K |
| D0120 |
Periodic oral evaluation - established patient |
9,919 |
9,641 |
$398K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,547 |
1,037 |
$354K |
| D1120 |
Prophylaxis - child |
9,158 |
9,017 |
$325K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,238 |
1,533 |
$284K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,893 |
15,727 |
$228K |
| D0210 |
Intraoral - complete series of radiographic images |
6,111 |
5,991 |
$212K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,626 |
9,464 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,459 |
1,337 |
$115K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,034 |
989 |
$110K |
| D9430 |
|
4,729 |
4,353 |
$109K |
| D0274 |
Bitewings - four radiographic images |
7,492 |
7,324 |
$97K |
| D4341 |
|
1,469 |
569 |
$86K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
181 |
144 |
$81K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
177 |
155 |
$77K |
| D1110 |
Prophylaxis - adult |
1,249 |
1,229 |
$71K |
| D9248 |
|
1,326 |
1,293 |
$70K |
| D1351 |
Sealant - per tooth |
2,056 |
480 |
$52K |
| D1310 |
|
1,233 |
1,226 |
$51K |
| D0272 |
Bitewings - two radiographic images |
3,853 |
3,811 |
$40K |
| D0350 |
|
5,473 |
1,781 |
$31K |
| D2740 |
Crown - porcelain/ceramic |
49 |
28 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
396 |
207 |
$21K |
| D0330 |
Panoramic radiographic image |
1,547 |
1,540 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
250 |
174 |
$16K |
| D9310 |
|
297 |
295 |
$15K |
| D1510 |
|
78 |
54 |
$14K |
| D1206 |
Topical application of fluoride varnish |
820 |
812 |
$13K |
| D9999 |
Unspecified adjunctive procedure, by report |
111 |
110 |
$12K |
| D1320 |
|
781 |
770 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
301 |
298 |
$9K |
| D2330 |
|
85 |
37 |
$7K |
| D9993 |
|
202 |
202 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
183 |
181 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
80 |
80 |
$6K |
| D4342 |
|
157 |
71 |
$6K |
| D2160 |
|
83 |
55 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,214 |
1,043 |
$6K |
| D0603 |
|
393 |
388 |
$6K |
| D0602 |
|
386 |
386 |
$5K |
| D8670 |
Periodic orthodontic treatment visit |
99 |
92 |
$5K |
| D4910 |
|
54 |
54 |
$4K |
| D0340 |
|
57 |
57 |
$2K |
| D9610 |
|
52 |
13 |
$1K |
| D2140 |
|
23 |
12 |
$600.60 |
| D0270 |
|
109 |
109 |
$150.00 |
| D0033 |
|
115 |
101 |
$0.00 |
| D1330 |
|
983 |
806 |
$0.00 |
| D0099 |
|
201 |
127 |
$0.00 |
| D9910 |
|
38 |
13 |
$0.00 |