| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,836 |
3,835 |
$222K |
| D0120 |
Periodic oral evaluation - established patient |
3,919 |
3,918 |
$159K |
| D0210 |
Intraoral - complete series of radiographic images |
2,536 |
2,534 |
$114K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,529 |
5,416 |
$99K |
| D1120 |
Prophylaxis - child |
2,426 |
2,420 |
$72K |
| D0274 |
Bitewings - four radiographic images |
3,328 |
3,318 |
$69K |
| D1110 |
Prophylaxis - adult |
920 |
919 |
$66K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
418 |
237 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
722 |
464 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,471 |
3,464 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
489 |
153 |
$27K |
| D4341 |
|
341 |
134 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
355 |
216 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
237 |
169 |
$16K |
| D9430 |
|
471 |
470 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
266 |
251 |
$10K |
| D0350 |
|
1,037 |
459 |
$9K |
| D0272 |
Bitewings - two radiographic images |
752 |
749 |
$9K |
| D1351 |
Sealant - per tooth |
224 |
32 |
$3K |
| D9910 |
|
67 |
67 |
$3K |
| D0330 |
Panoramic radiographic image |
106 |
106 |
$3K |
| D2330 |
|
23 |
15 |
$2K |
| D1206 |
Topical application of fluoride varnish |
111 |
111 |
$1K |
| D2160 |
|
16 |
13 |
$1K |
| D4910 |
|
13 |
13 |
$1K |
| D2140 |
|
18 |
13 |
$982.80 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$168.00 |
| D0270 |
|
12 |
12 |
$50.00 |
| D1999 |
|
52 |
49 |
$0.00 |