| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,239 |
3,218 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,974 |
2,965 |
$181K |
| D1120 |
Prophylaxis - child |
3,262 |
3,234 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,607 |
765 |
$105K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
890 |
373 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,060 |
4,973 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,902 |
1,898 |
$87K |
| D0274 |
Bitewings - four radiographic images |
3,299 |
3,279 |
$63K |
| D1110 |
Prophylaxis - adult |
546 |
545 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,615 |
3,585 |
$44K |
| D1351 |
Sealant - per tooth |
1,896 |
425 |
$41K |
| D9430 |
|
1,043 |
1,021 |
$32K |
| D0350 |
|
2,366 |
689 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
276 |
97 |
$15K |
| D0330 |
Panoramic radiographic image |
574 |
567 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
167 |
97 |
$13K |
| D7240 |
Removal of impacted tooth - completely bony |
50 |
20 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
207 |
112 |
$11K |
| D4341 |
|
136 |
48 |
$10K |
| D1320 |
|
489 |
482 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
15 |
$7K |
| D7230 |
|
25 |
13 |
$5K |
| D4910 |
|
51 |
51 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
299 |
297 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
91 |
91 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
188 |
185 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$455.00 |