| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,465 |
9,448 |
$590K |
| D0120 |
Periodic oral evaluation - established patient |
7,363 |
7,337 |
$390K |
| D0210 |
Intraoral - complete series of radiographic images |
6,602 |
6,589 |
$310K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,463 |
2,954 |
$299K |
| D2140 |
|
4,327 |
2,764 |
$236K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,706 |
9,561 |
$208K |
| D1110 |
Prophylaxis - adult |
2,357 |
2,346 |
$207K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,522 |
958 |
$180K |
| D1120 |
Prophylaxis - child |
4,843 |
4,834 |
$167K |
| D0274 |
Bitewings - four radiographic images |
7,737 |
7,703 |
$163K |
| D8670 |
Periodic orthodontic treatment visit |
418 |
418 |
$113K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,712 |
542 |
$98K |
| D4341 |
|
1,114 |
535 |
$76K |
| D1206 |
Topical application of fluoride varnish |
4,739 |
4,725 |
$62K |
| D0350 |
|
5,288 |
3,292 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
710 |
710 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,255 |
2,253 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
359 |
340 |
$14K |
| D0330 |
Panoramic radiographic image |
462 |
456 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
133 |
$11K |
| D2160 |
|
128 |
97 |
$10K |
| D0272 |
Bitewings - two radiographic images |
663 |
662 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
65 |
$6K |
| D9910 |
|
81 |
80 |
$4K |
| D2330 |
|
37 |
26 |
$3K |
| D1351 |
Sealant - per tooth |
70 |
16 |
$2K |
| D1999 |
|
2,095 |
2,093 |
$368.00 |