| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,047 |
15,950 |
$554K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,227 |
2,130 |
$469K |
| D0210 |
Intraoral - complete series of radiographic images |
6,037 |
5,894 |
$348K |
| D1120 |
Prophylaxis - child |
9,732 |
9,683 |
$310K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,049 |
16,924 |
$309K |
| D1110 |
Prophylaxis - adult |
5,206 |
5,182 |
$234K |
| D9410 |
|
2,232 |
1,981 |
$214K |
| D0274 |
Bitewings - four radiographic images |
6,704 |
6,664 |
$196K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,623 |
1,762 |
$193K |
| D0220 |
Intraoral - periapical first radiographic image |
17,117 |
16,693 |
$192K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,925 |
12,636 |
$132K |
| D1351 |
Sealant - per tooth |
5,163 |
1,434 |
$124K |
| D4346 |
|
898 |
896 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,924 |
1,088 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
3,648 |
3,587 |
$106K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,408 |
915 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,249 |
588 |
$82K |
| D0272 |
Bitewings - two radiographic images |
3,369 |
3,349 |
$69K |
| D9110 |
|
1,244 |
1,238 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,795 |
2,790 |
$64K |
| D4341 |
|
456 |
180 |
$54K |
| D2335 |
|
411 |
184 |
$52K |
| D2332 |
|
369 |
192 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
405 |
336 |
$34K |
| D2394 |
|
293 |
246 |
$32K |
| D5110 |
|
36 |
36 |
$28K |
| D2140 |
|
435 |
256 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
797 |
754 |
$22K |
| D0270 |
|
1,764 |
1,737 |
$18K |
| D2160 |
|
105 |
91 |
$9K |
| D2161 |
|
50 |
39 |
$5K |
| D0330 |
Panoramic radiographic image |
158 |
158 |
$3K |
| D7250 |
|
19 |
13 |
$2K |
| D2940 |
|
24 |
18 |
$1K |