| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,608 |
4,554 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
3,465 |
3,389 |
$160K |
| D0210 |
Intraoral - complete series of radiographic images |
3,334 |
3,287 |
$135K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,101 |
441 |
$131K |
| D1120 |
Prophylaxis - child |
3,293 |
3,211 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,486 |
744 |
$95K |
| D1110 |
Prophylaxis - adult |
1,258 |
1,247 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,074 |
5,734 |
$91K |
| D0274 |
Bitewings - four radiographic images |
3,405 |
3,334 |
$56K |
| D0350 |
|
7,526 |
1,989 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,001 |
472 |
$52K |
| D1351 |
Sealant - per tooth |
1,930 |
483 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,258 |
3,204 |
$44K |
| D9430 |
|
1,328 |
1,259 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
506 |
239 |
$40K |
| D1320 |
|
1,040 |
1,030 |
$17K |
| D4341 |
|
275 |
91 |
$17K |
| D0330 |
Panoramic radiographic image |
1,054 |
1,044 |
$8K |
| D9999 |
Unspecified adjunctive procedure, by report |
52 |
51 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
119 |
39 |
$6K |
| D0272 |
Bitewings - two radiographic images |
478 |
467 |
$5K |
| D7230 |
|
25 |
13 |
$5K |
| D9993 |
|
72 |
72 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
568 |
544 |
$3K |
| D1310 |
|
72 |
72 |
$3K |
| D2160 |
|
37 |
19 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
67 |
$2K |
| D2140 |
|
20 |
12 |
$992.80 |
| D1206 |
Topical application of fluoride varnish |
31 |
31 |
$730.02 |
| D0602 |
|
12 |
12 |
$172.50 |
| D0270 |
|
39 |
39 |
$160.00 |
| D1330 |
|
323 |
247 |
$0.00 |