| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,481 |
3,480 |
$215K |
| D0120 |
Periodic oral evaluation - established patient |
3,865 |
3,863 |
$175K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,596 |
1,536 |
$174K |
| D1120 |
Prophylaxis - child |
4,551 |
4,548 |
$138K |
| D0210 |
Intraoral - complete series of radiographic images |
2,864 |
2,863 |
$134K |
| D1351 |
Sealant - per tooth |
6,301 |
1,794 |
$130K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,989 |
979 |
$114K |
| D2140 |
|
1,782 |
1,078 |
$97K |
| D1110 |
Prophylaxis - adult |
1,154 |
1,153 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,713 |
5,097 |
$87K |
| D4341 |
|
1,063 |
289 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,653 |
2,653 |
$56K |
| D0350 |
|
4,934 |
2,313 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,979 |
4,975 |
$49K |
| D2160 |
|
516 |
366 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
308 |
233 |
$37K |
| D9993 |
|
332 |
332 |
$21K |
| D9430 |
|
665 |
651 |
$21K |
| D1310 |
|
332 |
332 |
$15K |
| D1206 |
Topical application of fluoride varnish |
741 |
740 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
82 |
$7K |
| D0272 |
Bitewings - two radiographic images |
274 |
274 |
$3K |
| D2330 |
|
23 |
13 |
$2K |
| D0603 |
|
85 |
85 |
$1K |
| D0270 |
|
79 |
79 |
$375.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
13 |
$48.96 |