| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,994 |
2,882 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
758 |
248 |
$995.80 |
| D0140 |
Limited oral evaluation - problem focused |
1,589 |
1,497 |
$797.44 |
| D0210 |
Intraoral - complete series of radiographic images |
1,009 |
961 |
$533.07 |
| D0220 |
Intraoral - periapical first radiographic image |
2,466 |
2,363 |
$336.10 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
276 |
101 |
$227.00 |
| D9995 |
|
963 |
925 |
$212.00 |
| D1206 |
Topical application of fluoride varnish |
2,766 |
2,657 |
$205.74 |
| D4910 |
|
408 |
386 |
$200.48 |
| D9996 |
|
409 |
390 |
$174.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
736 |
530 |
$139.80 |
| D0191 |
|
989 |
928 |
$132.04 |
| D0120 |
Periodic oral evaluation - established patient |
1,081 |
1,032 |
$130.15 |
| D0274 |
Bitewings - four radiographic images |
1,433 |
1,381 |
$113.24 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,456 |
1,080 |
$111.90 |
| D1110 |
Prophylaxis - adult |
1,117 |
1,083 |
$108.65 |
| D0270 |
|
239 |
234 |
$60.94 |
| D1120 |
Prophylaxis - child |
830 |
799 |
$52.24 |
| D1320 |
|
278 |
265 |
$39.06 |
| D1310 |
|
7,034 |
6,560 |
$0.00 |
| D0602 |
|
167 |
158 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
264 |
249 |
$0.00 |
| D1330 |
|
7,682 |
7,161 |
$0.00 |
| D0603 |
|
3,581 |
3,335 |
$0.00 |
| D0240 |
|
38 |
13 |
$0.00 |
| D0601 |
|
1,129 |
1,079 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$0.00 |
| D1351 |
Sealant - per tooth |
325 |
99 |
$0.00 |
| D0703 |
|
27 |
27 |
$0.00 |
| D2331 |
|
18 |
14 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
570 |
383 |
$0.00 |
| D4341 |
|
286 |
113 |
$0.00 |
| D1354 |
|
2,092 |
350 |
$0.00 |
| D9993 |
|
238 |
234 |
$0.00 |
| D0350 |
|
190 |
181 |
$0.00 |
| D0391 |
|
196 |
174 |
$0.00 |
| D0330 |
Panoramic radiographic image |
87 |
86 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
140 |
133 |
$0.00 |