| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,534 |
3,482 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
3,413 |
3,296 |
$120K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
859 |
419 |
$98K |
| D0210 |
Intraoral - complete series of radiographic images |
2,654 |
2,620 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,437 |
5,222 |
$73K |
| D1120 |
Prophylaxis - child |
1,856 |
1,804 |
$53K |
| D0274 |
Bitewings - four radiographic images |
3,191 |
3,123 |
$43K |
| D9430 |
|
1,377 |
1,339 |
$41K |
| D1110 |
Prophylaxis - adult |
557 |
550 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
625 |
324 |
$36K |
| D0330 |
Panoramic radiographic image |
1,241 |
1,223 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,890 |
1,842 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
323 |
170 |
$15K |
| D0350 |
|
1,348 |
355 |
$11K |
| D4341 |
|
146 |
47 |
$9K |
| D1351 |
Sealant - per tooth |
234 |
50 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
606 |
554 |
$4K |
| D1320 |
|
166 |
161 |
$2K |
| D0272 |
Bitewings - two radiographic images |
179 |
167 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$620.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$256.50 |
| D0270 |
|
12 |
12 |
$60.00 |
| D1330 |
|
101 |
77 |
$0.00 |
| D1999 |
|
21 |
13 |
$0.00 |