| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,964 |
2,953 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
3,171 |
3,156 |
$165K |
| D0210 |
Intraoral - complete series of radiographic images |
2,550 |
2,536 |
$120K |
| D1120 |
Prophylaxis - child |
2,566 |
2,552 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,090 |
3,858 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,674 |
2,655 |
$55K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
313 |
134 |
$37K |
| D1351 |
Sealant - per tooth |
1,399 |
388 |
$29K |
| D4341 |
|
396 |
142 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,678 |
1,662 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
373 |
216 |
$25K |
| D1110 |
Prophylaxis - adult |
278 |
278 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,718 |
1,715 |
$17K |
| D9910 |
|
160 |
160 |
$9K |
| D4910 |
|
92 |
92 |
$7K |
| D8670 |
Periodic orthodontic treatment visit |
14 |
14 |
$4K |
| D0350 |
|
399 |
157 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
42 |
$4K |
| D0330 |
Panoramic radiographic image |
255 |
253 |
$3K |
| D0272 |
Bitewings - two radiographic images |
197 |
192 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
30 |
$1K |
| D9430 |
|
44 |
44 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$875.00 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
26 |
$270.00 |
| D1330 |
|
801 |
789 |
$0.00 |