| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,451 |
7,185 |
$215K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,715 |
622 |
$199K |
| D1120 |
Prophylaxis - child |
4,847 |
4,656 |
$113K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,736 |
1,594 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
3,855 |
3,722 |
$99K |
| D1110 |
Prophylaxis - adult |
2,091 |
2,036 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,944 |
4,744 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
3,900 |
3,767 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,225 |
1,195 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,431 |
5,982 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
6,648 |
6,303 |
$47K |
| D0330 |
Panoramic radiographic image |
937 |
910 |
$34K |
| D1351 |
Sealant - per tooth |
1,903 |
527 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,913 |
1,862 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
429 |
179 |
$19K |
| D4341 |
|
452 |
164 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
285 |
188 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,598 |
1,518 |
$12K |
| D9999 |
Unspecified adjunctive procedure, by report |
104 |
95 |
$11K |
| D9430 |
|
639 |
595 |
$9K |
| D1999 |
|
100 |
100 |
$6K |
| D1206 |
Topical application of fluoride varnish |
352 |
333 |
$6K |
| D0999 |
Unspecified diagnostic procedure, by report |
66 |
66 |
$4K |
| D2331 |
|
72 |
43 |
$3K |
| D1310 |
|
537 |
526 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
156 |
151 |
$2K |
| D2332 |
|
42 |
25 |
$2K |
| D2335 |
|
26 |
15 |
$2K |
| D0350 |
|
133 |
85 |
$1K |
| D0603 |
|
312 |
303 |
$711.00 |
| D0270 |
|
192 |
187 |
$465.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$59.00 |
| D0602 |
|
45 |
45 |
$30.00 |
| D0601 |
|
32 |
31 |
$11.00 |
| D9993 |
|
492 |
484 |
$0.00 |
| D0191 |
|
93 |
93 |
$0.00 |
| D9910 |
|
75 |
27 |
$0.00 |