| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,288 |
7,268 |
$453K |
| D0120 |
Periodic oral evaluation - established patient |
9,062 |
9,039 |
$445K |
| D1120 |
Prophylaxis - child |
6,697 |
6,670 |
$235K |
| D8670 |
Periodic orthodontic treatment visit |
853 |
853 |
$235K |
| D0210 |
Intraoral - complete series of radiographic images |
4,691 |
4,675 |
$220K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,440 |
10,840 |
$212K |
| D1110 |
Prophylaxis - adult |
2,263 |
2,258 |
$183K |
| D0274 |
Bitewings - four radiographic images |
8,177 |
8,138 |
$170K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
823 |
467 |
$96K |
| D1206 |
Topical application of fluoride varnish |
6,222 |
6,194 |
$74K |
| D4341 |
|
1,085 |
468 |
$72K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
942 |
565 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
652 |
395 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,015 |
3,009 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
568 |
317 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
717 |
716 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
417 |
159 |
$24K |
| D2140 |
|
344 |
210 |
$19K |
| D0330 |
Panoramic radiographic image |
863 |
862 |
$17K |
| D0350 |
|
1,693 |
1,010 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
317 |
289 |
$12K |
| D0272 |
Bitewings - two radiographic images |
831 |
829 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
53 |
$5K |
| D1351 |
Sealant - per tooth |
140 |
29 |
$5K |
| D9910 |
|
80 |
80 |
$5K |
| D4910 |
|
41 |
41 |
$3K |
| D9430 |
|
14 |
13 |
$448.00 |
| D1330 |
|
1,203 |
1,185 |
$0.00 |