| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,144 |
2,123 |
$194K |
| D0140 |
Limited oral evaluation - problem focused |
2,124 |
1,944 |
$183K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,683 |
807 |
$141K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
947 |
484 |
$126K |
| D1110 |
Prophylaxis - adult |
1,243 |
1,233 |
$105K |
| D4355 |
|
420 |
411 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
1,210 |
1,197 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
187 |
186 |
$17K |
| D0330 |
Panoramic radiographic image |
828 |
815 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,199 |
1,155 |
$10K |
| D1351 |
Sealant - per tooth |
220 |
24 |
$6K |
| D1206 |
Topical application of fluoride varnish |
172 |
172 |
$4K |
| D4341 |
|
28 |
13 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
33 |
27 |
$3K |
| D0274 |
Bitewings - four radiographic images |
363 |
359 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
489 |
366 |
$3K |
| D1120 |
Prophylaxis - child |
80 |
80 |
$3K |
| D2140 |
|
16 |
13 |
$2K |
| D7230 |
|
17 |
12 |
$1K |
| D0270 |
|
46 |
43 |
$204.62 |