| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,255 |
6,243 |
$386K |
| D0120 |
Periodic oral evaluation - established patient |
4,344 |
4,331 |
$243K |
| D0210 |
Intraoral - complete series of radiographic images |
5,115 |
5,100 |
$237K |
| D1120 |
Prophylaxis - child |
4,717 |
4,690 |
$180K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,160 |
664 |
$137K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,367 |
6,030 |
$126K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,711 |
913 |
$115K |
| D0274 |
Bitewings - four radiographic images |
3,011 |
2,987 |
$61K |
| D1351 |
Sealant - per tooth |
2,100 |
484 |
$56K |
| D1110 |
Prophylaxis - adult |
671 |
665 |
$52K |
| D2160 |
|
541 |
322 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,445 |
3,433 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,221 |
2,200 |
$35K |
| D4341 |
|
361 |
112 |
$25K |
| D0330 |
Panoramic radiographic image |
987 |
982 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
186 |
100 |
$12K |
| D1310 |
|
250 |
250 |
$11K |
| D9430 |
|
310 |
310 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
237 |
232 |
$9K |
| D8670 |
Periodic orthodontic treatment visit |
27 |
27 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
231 |
231 |
$8K |
| D0272 |
Bitewings - two radiographic images |
649 |
641 |
$7K |
| D2140 |
|
136 |
80 |
$7K |
| D9993 |
|
114 |
114 |
$7K |
| D0350 |
|
695 |
341 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
75 |
42 |
$6K |
| D9910 |
|
115 |
113 |
$6K |
| D4910 |
|
71 |
70 |
$5K |
| D2161 |
|
38 |
36 |
$3K |
| D0602 |
|
149 |
149 |
$2K |
| D4342 |
|
36 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
14 |
$1K |
| D1330 |
|
299 |
292 |
$0.00 |