| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,138 |
1,065 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
2,360 |
2,015 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,902 |
1,978 |
$714.00 |
| D1110 |
Prophylaxis - adult |
304 |
272 |
$0.00 |
| D9993 |
|
1,226 |
1,211 |
$0.00 |
| D0270 |
|
528 |
454 |
$0.00 |
| D2140 |
|
274 |
238 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
698 |
562 |
$0.00 |
| D0330 |
Panoramic radiographic image |
1,969 |
1,686 |
$0.00 |
| D9430 |
|
3,693 |
3,202 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,347 |
1,333 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
589 |
488 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,121 |
1,089 |
$0.00 |
| D4921 |
|
50 |
18 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
38 |
$0.00 |
| D4341 |
|
93 |
32 |
$0.00 |
| D1310 |
|
1,222 |
1,207 |
$0.00 |
| D0603 |
|
615 |
611 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,604 |
2,416 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
106 |
77 |
$0.00 |
| D1351 |
Sealant - per tooth |
963 |
246 |
$0.00 |
| D7230 |
|
509 |
380 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
772 |
301 |
$0.00 |
| D7250 |
|
961 |
354 |
$0.00 |
| D0602 |
|
296 |
289 |
$0.00 |
| D7953 |
|
186 |
96 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
378 |
359 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,691 |
1,648 |
$0.00 |
| D0601 |
|
237 |
237 |
$0.00 |
| D1330 |
|
3,422 |
3,081 |
$0.00 |
| D2160 |
|
126 |
117 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,424 |
1,356 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
626 |
398 |
$0.00 |
| D7220 |
|
27 |
13 |
$0.00 |
| D7240 |
Removal of impacted tooth - completely bony |
501 |
362 |
$0.00 |