| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,317 |
6,296 |
$415K |
| D0210 |
Intraoral - complete series of radiographic images |
4,987 |
4,967 |
$238K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,535 |
798 |
$181K |
| D4341 |
|
1,248 |
500 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
1,407 |
1,400 |
$83K |
| D1110 |
Prophylaxis - adult |
927 |
924 |
$82K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
908 |
555 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,276 |
2,940 |
$58K |
| D1120 |
Prophylaxis - child |
1,636 |
1,632 |
$57K |
| D8670 |
Periodic orthodontic treatment visit |
192 |
192 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,097 |
2,079 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
565 |
370 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,388 |
2,383 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
470 |
301 |
$26K |
| D1351 |
Sealant - per tooth |
932 |
227 |
$21K |
| D2140 |
|
322 |
197 |
$18K |
| D0330 |
Panoramic radiographic image |
1,535 |
1,515 |
$17K |
| D0350 |
|
1,356 |
791 |
$13K |
| D4342 |
|
161 |
70 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
82 |
58 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
383 |
383 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
103 |
103 |
$4K |
| D2330 |
|
38 |
28 |
$3K |
| D2160 |
|
35 |
30 |
$3K |
| D4910 |
|
38 |
38 |
$3K |
| D0272 |
Bitewings - two radiographic images |
112 |
109 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22 |
19 |
$840.00 |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
56 |
$665.00 |
| D9430 |
|
12 |
12 |
$384.00 |
| D1330 |
|
1,273 |
1,267 |
$0.00 |