| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,664 |
3,654 |
$222K |
| D0120 |
Periodic oral evaluation - established patient |
2,852 |
2,841 |
$140K |
| D0210 |
Intraoral - complete series of radiographic images |
3,008 |
2,994 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,784 |
1,047 |
$119K |
| D1110 |
Prophylaxis - adult |
1,355 |
1,353 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,143 |
3,897 |
$86K |
| D0274 |
Bitewings - four radiographic images |
3,325 |
3,299 |
$69K |
| D8670 |
Periodic orthodontic treatment visit |
239 |
239 |
$66K |
| D1120 |
Prophylaxis - child |
1,916 |
1,911 |
$61K |
| D4341 |
|
705 |
244 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,256 |
3,245 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
595 |
358 |
$32K |
| D9910 |
|
513 |
512 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
222 |
106 |
$25K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
49 |
42 |
$23K |
| D4342 |
|
618 |
224 |
$22K |
| D4910 |
|
239 |
238 |
$17K |
| D0350 |
|
1,508 |
754 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
122 |
92 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
50 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
99 |
88 |
$3K |
| D1351 |
Sealant - per tooth |
118 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
96 |
95 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$385.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$325.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$206.00 |
| D4381 |
|
634 |
120 |
$0.00 |