| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,190 |
5,154 |
$297K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,113 |
1,007 |
$248K |
| D0210 |
Intraoral - complete series of radiographic images |
4,254 |
4,224 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
3,627 |
3,552 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,144 |
5,668 |
$81K |
| D1120 |
Prophylaxis - child |
1,937 |
1,899 |
$61K |
| D0274 |
Bitewings - four radiographic images |
4,022 |
3,951 |
$58K |
| D4341 |
|
1,077 |
381 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
830 |
457 |
$50K |
| D9430 |
|
1,627 |
1,588 |
$49K |
| D7240 |
Removal of impacted tooth - completely bony |
199 |
76 |
$37K |
| D1110 |
Prophylaxis - adult |
484 |
483 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,747 |
1,723 |
$23K |
| D0330 |
Panoramic radiographic image |
1,077 |
1,068 |
$20K |
| D1351 |
Sealant - per tooth |
762 |
168 |
$17K |
| D2740 |
Crown - porcelain/ceramic |
33 |
26 |
$16K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
31 |
25 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
235 |
145 |
$12K |
| D4910 |
|
139 |
139 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,708 |
1,571 |
$7K |
| D0350 |
|
395 |
314 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
33 |
27 |
$4K |
| D1320 |
|
175 |
175 |
$3K |
| D1206 |
Topical application of fluoride varnish |
212 |
212 |
$3K |
| D0272 |
Bitewings - two radiographic images |
280 |
268 |
$2K |
| D9310 |
|
36 |
36 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
37 |
$1K |
| D4342 |
|
26 |
12 |
$972.00 |
| D0270 |
|
16 |
16 |
$80.00 |
| D1330 |
|
884 |
833 |
$0.00 |
| D0033 |
|
56 |
50 |
$0.00 |
| D8670 |
Periodic orthodontic treatment visit |
15 |
15 |
$0.00 |