| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,128 |
3,121 |
$188K |
| D0120 |
Periodic oral evaluation - established patient |
2,335 |
2,330 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
1,932 |
1,924 |
$89K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
626 |
308 |
$74K |
| D8670 |
Periodic orthodontic treatment visit |
266 |
266 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,279 |
3,115 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,145 |
2,137 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
617 |
333 |
$41K |
| D1120 |
Prophylaxis - child |
1,010 |
1,010 |
$32K |
| D4341 |
|
506 |
215 |
$31K |
| D1110 |
Prophylaxis - adult |
373 |
372 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,195 |
1,194 |
$11K |
| D2140 |
|
186 |
107 |
$10K |
| D0330 |
Panoramic radiographic image |
421 |
420 |
$8K |
| D2160 |
|
96 |
57 |
$8K |
| D9910 |
|
152 |
148 |
$7K |
| D1206 |
Topical application of fluoride varnish |
463 |
462 |
$7K |
| D2330 |
|
70 |
37 |
$5K |
| D0350 |
|
523 |
321 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
81 |
81 |
$3K |
| D9430 |
|
72 |
72 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
14 |
$2K |
| D1351 |
Sealant - per tooth |
71 |
15 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$404.00 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$265.00 |
| D1330 |
|
200 |
200 |
$0.00 |