| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,196 |
5,183 |
$321K |
| D0120 |
Periodic oral evaluation - established patient |
5,770 |
5,752 |
$290K |
| D0210 |
Intraoral - complete series of radiographic images |
3,757 |
3,743 |
$174K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,641 |
7,267 |
$152K |
| D1120 |
Prophylaxis - child |
4,172 |
4,167 |
$152K |
| D8670 |
Periodic orthodontic treatment visit |
470 |
470 |
$127K |
| D0274 |
Bitewings - four radiographic images |
4,921 |
4,880 |
$100K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,128 |
681 |
$75K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
486 |
259 |
$57K |
| D1351 |
Sealant - per tooth |
1,509 |
335 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,024 |
4,020 |
$43K |
| D1110 |
Prophylaxis - adult |
407 |
404 |
$31K |
| D2140 |
|
516 |
347 |
$28K |
| D4341 |
|
335 |
160 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
580 |
577 |
$20K |
| D0350 |
|
1,824 |
821 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,257 |
1,253 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
343 |
320 |
$13K |
| D0330 |
Panoramic radiographic image |
567 |
558 |
$12K |
| D1206 |
Topical application of fluoride varnish |
565 |
559 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
62 |
$6K |
| D2160 |
|
72 |
42 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
58 |
$5K |
| D9910 |
|
109 |
105 |
$3K |
| D9430 |
|
94 |
91 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
14 |
$2K |
| D1999 |
|
480 |
457 |
$46.00 |
| D4921 |
|
471 |
140 |
$0.00 |