| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
26,014 |
25,928 |
$1.50M |
| D2740 |
Crown - porcelain/ceramic |
2,025 |
1,528 |
$962K |
| D1120 |
Prophylaxis - child |
21,105 |
21,038 |
$820K |
| D0230 |
Intraoral - periapical each additional radiographic image |
164,290 |
29,178 |
$667K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,285 |
10,250 |
$650K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
9,345 |
6,541 |
$625K |
| D4341 |
|
8,951 |
2,573 |
$623K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,171 |
2,809 |
$608K |
| D1110 |
Prophylaxis - adult |
6,304 |
6,273 |
$541K |
| D0274 |
Bitewings - four radiographic images |
25,397 |
25,299 |
$541K |
| D0210 |
Intraoral - complete series of radiographic images |
8,593 |
8,561 |
$401K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,433 |
28,332 |
$325K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
631 |
561 |
$291K |
| D4910 |
|
3,515 |
3,506 |
$270K |
| D7230 |
|
974 |
477 |
$184K |
| D1351 |
Sealant - per tooth |
6,630 |
1,741 |
$182K |
| D2954 |
|
1,080 |
829 |
$113K |
| D3320 |
|
253 |
215 |
$92K |
| D4342 |
|
2,074 |
653 |
$87K |
| D2140 |
|
1,581 |
1,191 |
$86K |
| D2160 |
|
933 |
799 |
$74K |
| D0330 |
Panoramic radiographic image |
2,479 |
2,471 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
856 |
607 |
$58K |
| D9430 |
|
1,433 |
1,418 |
$45K |
| D2330 |
|
508 |
336 |
$39K |
| D7240 |
Removal of impacted tooth - completely bony |
168 |
96 |
$39K |
| D2331 |
|
330 |
232 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
257 |
91 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
270 |
192 |
$15K |
| D0350 |
|
1,510 |
744 |
$14K |
| D3310 |
|
45 |
25 |
$14K |
| D0272 |
Bitewings - two radiographic images |
845 |
840 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
110 |
92 |
$9K |
| D0270 |
|
410 |
405 |
$2K |
| D7111 |
|
24 |
16 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
71 |
71 |
$824.00 |