| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,402 |
7,377 |
$461K |
| D0210 |
Intraoral - complete series of radiographic images |
5,612 |
5,588 |
$263K |
| D0120 |
Periodic oral evaluation - established patient |
4,147 |
4,136 |
$212K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,248 |
1,206 |
$150K |
| D4341 |
|
2,108 |
737 |
$147K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,664 |
6,193 |
$127K |
| D2140 |
|
2,038 |
1,040 |
$111K |
| D1120 |
Prophylaxis - child |
2,735 |
2,728 |
$99K |
| D0274 |
Bitewings - four radiographic images |
4,406 |
4,364 |
$91K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
674 |
331 |
$80K |
| D8670 |
Periodic orthodontic treatment visit |
203 |
203 |
$56K |
| D1351 |
Sealant - per tooth |
2,132 |
485 |
$53K |
| D1110 |
Prophylaxis - adult |
566 |
566 |
$49K |
| D9430 |
|
1,053 |
1,038 |
$32K |
| D0350 |
|
3,068 |
1,304 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,249 |
2,243 |
$24K |
| D0330 |
Panoramic radiographic image |
926 |
915 |
$21K |
| D1206 |
Topical application of fluoride varnish |
997 |
991 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
346 |
345 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
811 |
797 |
$10K |
| D2160 |
|
88 |
68 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
159 |
152 |
$6K |
| D0272 |
Bitewings - two radiographic images |
508 |
500 |
$6K |
| D4910 |
|
68 |
68 |
$5K |
| D4342 |
|
94 |
41 |
$4K |
| D9910 |
|
113 |
113 |
$3K |
| D2331 |
|
24 |
13 |
$2K |
| D9993 |
|
13 |
13 |
$780.00 |
| D1310 |
|
13 |
13 |
$552.00 |
| D1330 |
|
71 |
71 |
$0.00 |