| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,444 |
6,423 |
$400K |
| D0120 |
Periodic oral evaluation - established patient |
5,717 |
5,682 |
$310K |
| D0210 |
Intraoral - complete series of radiographic images |
4,632 |
4,616 |
$216K |
| D1120 |
Prophylaxis - child |
5,554 |
5,533 |
$205K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,493 |
8,113 |
$177K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,203 |
1,329 |
$148K |
| D1110 |
Prophylaxis - adult |
1,799 |
1,791 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,021 |
1,240 |
$134K |
| D8670 |
Periodic orthodontic treatment visit |
453 |
451 |
$127K |
| D0274 |
Bitewings - four radiographic images |
5,428 |
5,376 |
$113K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
684 |
282 |
$79K |
| D1206 |
Topical application of fluoride varnish |
4,738 |
4,705 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,215 |
786 |
$65K |
| D2140 |
|
981 |
655 |
$53K |
| D9910 |
|
644 |
642 |
$37K |
| D0350 |
|
3,842 |
1,836 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,469 |
2,467 |
$23K |
| D2160 |
|
280 |
193 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
656 |
646 |
$22K |
| D4341 |
|
338 |
122 |
$22K |
| D1351 |
Sealant - per tooth |
1,036 |
245 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,255 |
1,250 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
354 |
332 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
15 |
$7K |
| D1310 |
|
152 |
152 |
$7K |
| D9993 |
|
100 |
100 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
68 |
51 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
48 |
$4K |
| D4910 |
|
37 |
37 |
$3K |
| D0330 |
Panoramic radiographic image |
141 |
139 |
$2K |
| D9430 |
|
62 |
60 |
$2K |
| D1330 |
|
2,691 |
2,662 |
$0.00 |