| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,042 |
4,036 |
$266K |
| D0210 |
Intraoral - complete series of radiographic images |
3,344 |
3,342 |
$159K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,295 |
532 |
$154K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,695 |
949 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
1,390 |
1,385 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,876 |
2,778 |
$61K |
| D1120 |
Prophylaxis - child |
1,457 |
1,457 |
$54K |
| D1110 |
Prophylaxis - adult |
555 |
555 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
808 |
430 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,823 |
1,807 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,319 |
2,312 |
$28K |
| D4341 |
|
314 |
108 |
$22K |
| D4910 |
|
218 |
218 |
$17K |
| D9430 |
|
491 |
486 |
$16K |
| D0350 |
|
1,188 |
653 |
$12K |
| D1351 |
Sealant - per tooth |
525 |
118 |
$11K |
| D8670 |
Periodic orthodontic treatment visit |
26 |
26 |
$8K |
| D0330 |
Panoramic radiographic image |
294 |
294 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
92 |
92 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
138 |
136 |
$2K |
| D4342 |
|
28 |
13 |
$1K |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$322.00 |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$312.00 |