| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,736 |
5,688 |
$333K |
| D0120 |
Periodic oral evaluation - established patient |
5,753 |
5,641 |
$227K |
| D0210 |
Intraoral - complete series of radiographic images |
5,016 |
4,969 |
$195K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,633 |
733 |
$189K |
| D1110 |
Prophylaxis - adult |
2,257 |
2,228 |
$149K |
| D1120 |
Prophylaxis - child |
4,010 |
3,953 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,926 |
882 |
$119K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,209 |
6,776 |
$79K |
| D0274 |
Bitewings - four radiographic images |
4,766 |
4,707 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,294 |
636 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,936 |
4,880 |
$58K |
| D1351 |
Sealant - per tooth |
1,000 |
219 |
$27K |
| D1320 |
|
1,851 |
1,840 |
$26K |
| D9430 |
|
768 |
754 |
$21K |
| D4341 |
|
311 |
114 |
$19K |
| D0350 |
|
1,846 |
1,004 |
$18K |
| D9999 |
Unspecified adjunctive procedure, by report |
115 |
111 |
$16K |
| D0330 |
Panoramic radiographic image |
1,332 |
1,332 |
$13K |
| D8670 |
Periodic orthodontic treatment visit |
69 |
69 |
$10K |
| D7240 |
Removal of impacted tooth - completely bony |
43 |
17 |
$9K |
| D1206 |
Topical application of fluoride varnish |
427 |
426 |
$7K |
| D0272 |
Bitewings - two radiographic images |
720 |
699 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
26 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
17 |
$2K |
| D9993 |
|
30 |
29 |
$2K |
| D2954 |
|
15 |
12 |
$2K |
| D1310 |
|
29 |
29 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
272 |
249 |
$1K |
| D1354 |
|
29 |
29 |
$892.50 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$560.00 |
| D0601 |
|
14 |
14 |
$3.00 |
| D1330 |
|
280 |
256 |
$0.00 |