| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,661 |
4,649 |
$308K |
| D0120 |
Periodic oral evaluation - established patient |
2,672 |
2,654 |
$194K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,710 |
1,397 |
$182K |
| D1120 |
Prophylaxis - child |
3,311 |
3,297 |
$144K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,106 |
6,608 |
$115K |
| D1110 |
Prophylaxis - adult |
1,226 |
1,216 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
2,118 |
2,113 |
$101K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
810 |
340 |
$96K |
| D0274 |
Bitewings - four radiographic images |
2,991 |
2,976 |
$63K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
133 |
110 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,650 |
4,626 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,876 |
4,245 |
$58K |
| D2140 |
|
1,070 |
626 |
$58K |
| D9430 |
|
1,810 |
1,747 |
$58K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
122 |
114 |
$57K |
| D2160 |
|
610 |
396 |
$49K |
| D4910 |
|
603 |
596 |
$46K |
| D0330 |
Panoramic radiographic image |
1,523 |
1,513 |
$45K |
| D7240 |
Removal of impacted tooth - completely bony |
86 |
38 |
$20K |
| D4341 |
|
218 |
61 |
$15K |
| D0272 |
Bitewings - two radiographic images |
452 |
447 |
$5K |
| D7230 |
|
25 |
12 |
$5K |
| D2954 |
|
45 |
43 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
15 |
$2K |
| D2952 |
|
19 |
12 |
$2K |
| D0350 |
|
35 |
12 |
$336.00 |