| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,847 |
4,823 |
$300K |
| D0120 |
Periodic oral evaluation - established patient |
2,693 |
2,683 |
$150K |
| D0210 |
Intraoral - complete series of radiographic images |
3,131 |
3,115 |
$146K |
| D1110 |
Prophylaxis - adult |
1,615 |
1,606 |
$139K |
| D1120 |
Prophylaxis - child |
3,530 |
3,518 |
$127K |
| D0274 |
Bitewings - four radiographic images |
2,190 |
2,182 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,686 |
3,671 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,982 |
4,335 |
$32K |
| D9430 |
|
872 |
820 |
$27K |
| D9993 |
|
367 |
367 |
$19K |
| D0350 |
|
1,973 |
504 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
153 |
85 |
$17K |
| D1310 |
|
368 |
368 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,067 |
1,061 |
$12K |
| D1206 |
Topical application of fluoride varnish |
275 |
275 |
$4K |
| D4341 |
|
55 |
14 |
$4K |
| D1351 |
Sealant - per tooth |
174 |
48 |
$4K |
| D0602 |
|
210 |
209 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
391 |
386 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
14 |
$1K |
| D0601 |
|
119 |
118 |
$990.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$762.00 |
| D1320 |
|
15 |
15 |
$140.00 |
| D0270 |
|
12 |
12 |
$57.50 |