| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,696 |
2,692 |
$163K |
| D0120 |
Periodic oral evaluation - established patient |
2,969 |
2,960 |
$156K |
| D1120 |
Prophylaxis - child |
3,059 |
3,040 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,065 |
4,616 |
$98K |
| D0210 |
Intraoral - complete series of radiographic images |
1,616 |
1,613 |
$75K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
595 |
234 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,899 |
2,886 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
812 |
438 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
595 |
219 |
$33K |
| D0350 |
|
3,871 |
1,162 |
$33K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
288 |
54 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,674 |
2,665 |
$32K |
| D1110 |
Prophylaxis - adult |
359 |
357 |
$29K |
| D9430 |
|
532 |
523 |
$16K |
| D1351 |
Sealant - per tooth |
731 |
191 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
324 |
319 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
206 |
124 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
100 |
27 |
$10K |
| D1206 |
Topical application of fluoride varnish |
775 |
767 |
$9K |
| D9993 |
|
150 |
150 |
$9K |
| D0272 |
Bitewings - two radiographic images |
662 |
658 |
$7K |
| D0330 |
Panoramic radiographic image |
384 |
384 |
$7K |
| D1320 |
|
381 |
381 |
$6K |
| D1310 |
|
149 |
149 |
$6K |
| D7240 |
Removal of impacted tooth - completely bony |
22 |
12 |
$5K |
| D7230 |
|
19 |
12 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
32 |
32 |
$1K |
| D0603 |
|
64 |
64 |
$930.00 |
| D1354 |
|
38 |
38 |
$735.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$156.00 |
| D0270 |
|
12 |
12 |
$60.00 |
| D0601 |
|
12 |
12 |
$0.00 |