| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,894 |
3,808 |
$219K |
| D1110 |
Prophylaxis - adult |
1,758 |
1,744 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
2,227 |
2,210 |
$98K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
571 |
327 |
$89K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
88 |
80 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
1,416 |
1,385 |
$35K |
| D9999 |
Unspecified adjunctive procedure, by report |
292 |
275 |
$35K |
| D0274 |
Bitewings - four radiographic images |
2,240 |
2,217 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,560 |
1,554 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,319 |
2,675 |
$27K |
| D1120 |
Prophylaxis - child |
841 |
836 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
301 |
121 |
$22K |
| D4910 |
|
346 |
343 |
$18K |
| D9430 |
|
662 |
631 |
$17K |
| D4341 |
|
219 |
59 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,544 |
1,517 |
$9K |
| D1320 |
|
914 |
912 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
26 |
$3K |
| D0330 |
Panoramic radiographic image |
40 |
40 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$980.20 |
| D1999 |
|
268 |
245 |
$230.00 |
| D0270 |
|
27 |
27 |
$76.50 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$0.00 |