| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,385 |
3,360 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
4,134 |
4,005 |
$188K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,245 |
554 |
$133K |
| D0210 |
Intraoral - complete series of radiographic images |
3,207 |
3,159 |
$129K |
| D1120 |
Prophylaxis - child |
2,869 |
2,818 |
$95K |
| D1110 |
Prophylaxis - adult |
1,307 |
1,270 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,714 |
4,467 |
$78K |
| D0274 |
Bitewings - four radiographic images |
3,725 |
3,634 |
$65K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
76 |
69 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,696 |
2,632 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
484 |
187 |
$32K |
| D9430 |
|
695 |
667 |
$21K |
| D4341 |
|
289 |
84 |
$20K |
| D0350 |
|
1,185 |
624 |
$18K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
37 |
26 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,403 |
1,377 |
$12K |
| D0330 |
Panoramic radiographic image |
782 |
771 |
$7K |
| D1351 |
Sealant - per tooth |
301 |
71 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
65 |
36 |
$4K |
| D7230 |
|
21 |
12 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
307 |
243 |
$2K |
| D2954 |
|
14 |
12 |
$1K |
| D2140 |
|
24 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
121 |
120 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$1K |
| D1330 |
|
313 |
259 |
$0.00 |