| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,149 |
6,071 |
$310K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,841 |
4,805 |
$293K |
| D1120 |
Prophylaxis - child |
6,136 |
6,033 |
$223K |
| D0210 |
Intraoral - complete series of radiographic images |
3,218 |
3,176 |
$147K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,175 |
7,659 |
$111K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
232 |
148 |
$108K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
638 |
256 |
$73K |
| D0274 |
Bitewings - four radiographic images |
3,348 |
3,283 |
$69K |
| D1351 |
Sealant - per tooth |
2,808 |
623 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,019 |
4,963 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
763 |
387 |
$50K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
89 |
69 |
$40K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
173 |
112 |
$33K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
498 |
272 |
$33K |
| D4910 |
|
400 |
400 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
523 |
319 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
347 |
320 |
$13K |
| D1110 |
Prophylaxis - adult |
155 |
154 |
$13K |
| D3320 |
|
31 |
24 |
$11K |
| D9222 |
|
97 |
97 |
$10K |
| D0272 |
Bitewings - two radiographic images |
730 |
727 |
$8K |
| D4341 |
|
117 |
33 |
$8K |
| D9610 |
|
124 |
79 |
$6K |
| D9430 |
|
169 |
164 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
24 |
$3K |
| D0350 |
|
236 |
123 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
54 |
$2K |
| D0330 |
Panoramic radiographic image |
55 |
54 |
$2K |
| D2160 |
|
20 |
12 |
$2K |
| D2140 |
|
26 |
15 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
50 |
50 |
$574.00 |
| D1999 |
|
60 |
57 |
$25.00 |
| D9910 |
|
57 |
25 |
$0.00 |