| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,483 |
3,407 |
$164K |
| D0120 |
Periodic oral evaluation - established patient |
4,003 |
3,856 |
$118K |
| D0210 |
Intraoral - complete series of radiographic images |
3,201 |
3,150 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,328 |
5,550 |
$68K |
| D1110 |
Prophylaxis - adult |
1,358 |
1,315 |
$59K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
418 |
210 |
$53K |
| D1120 |
Prophylaxis - child |
2,154 |
2,077 |
$53K |
| D0274 |
Bitewings - four radiographic images |
4,362 |
4,231 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,258 |
2,206 |
$25K |
| D4341 |
|
233 |
76 |
$15K |
| D9430 |
|
465 |
456 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
129 |
78 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
144 |
65 |
$7K |
| D1351 |
Sealant - per tooth |
237 |
47 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
99 |
58 |
$5K |
| D0330 |
Panoramic radiographic image |
556 |
532 |
$4K |
| D1320 |
|
283 |
281 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
480 |
453 |
$3K |
| D9310 |
|
42 |
41 |
$2K |
| D0350 |
|
2,141 |
2,014 |
$2K |
| D2140 |
|
45 |
27 |
$2K |
| D1330 |
|
2,458 |
2,332 |
$0.00 |