| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,956 |
3,953 |
$236K |
| D0120 |
Periodic oral evaluation - established patient |
5,374 |
5,372 |
$222K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,746 |
6,616 |
$128K |
| D1110 |
Prophylaxis - adult |
1,632 |
1,631 |
$125K |
| D1120 |
Prophylaxis - child |
4,115 |
4,113 |
$123K |
| D0210 |
Intraoral - complete series of radiographic images |
2,466 |
2,466 |
$114K |
| D0274 |
Bitewings - four radiographic images |
4,543 |
4,529 |
$94K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
500 |
275 |
$59K |
| D4341 |
|
784 |
321 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
651 |
408 |
$44K |
| D1206 |
Topical application of fluoride varnish |
2,309 |
2,308 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,136 |
3,135 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
533 |
342 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
392 |
277 |
$26K |
| D1351 |
Sealant - per tooth |
1,144 |
277 |
$23K |
| D2140 |
|
292 |
192 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
228 |
66 |
$13K |
| D9430 |
|
366 |
366 |
$11K |
| D0350 |
|
1,302 |
784 |
$11K |
| D0272 |
Bitewings - two radiographic images |
872 |
869 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
193 |
184 |
$7K |
| D9910 |
|
123 |
123 |
$7K |
| D0330 |
Panoramic radiographic image |
213 |
209 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
311 |
301 |
$4K |
| D4342 |
|
54 |
26 |
$2K |
| D2160 |
|
17 |
12 |
$1K |
| D4910 |
|
12 |
12 |
$770.00 |
| D0140 |
Limited oral evaluation - problem focused |
49 |
49 |
$0.00 |
| D1999 |
|
95 |
95 |
$0.00 |