| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,157 |
11,131 |
$579K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,055 |
9,019 |
$566K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,543 |
1,867 |
$420K |
| D1110 |
Prophylaxis - adult |
4,451 |
4,440 |
$383K |
| D4341 |
|
5,200 |
1,602 |
$358K |
| D0210 |
Intraoral - complete series of radiographic images |
6,084 |
6,051 |
$285K |
| D1120 |
Prophylaxis - child |
7,730 |
7,714 |
$278K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,754 |
2,165 |
$251K |
| D0274 |
Bitewings - four radiographic images |
11,034 |
11,001 |
$233K |
| D8670 |
Periodic orthodontic treatment visit |
816 |
807 |
$224K |
| D2740 |
Crown - porcelain/ceramic |
383 |
276 |
$181K |
| D1351 |
Sealant - per tooth |
6,270 |
1,395 |
$172K |
| D4910 |
|
1,990 |
1,976 |
$151K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,069 |
13,934 |
$137K |
| D2140 |
|
2,145 |
1,311 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,345 |
9,333 |
$99K |
| D4342 |
|
1,597 |
630 |
$67K |
| D1206 |
Topical application of fluoride varnish |
3,542 |
3,519 |
$61K |
| D0330 |
Panoramic radiographic image |
2,033 |
2,015 |
$57K |
| D2160 |
|
593 |
407 |
$47K |
| D9910 |
|
696 |
692 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
842 |
837 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
469 |
153 |
$27K |
| D0350 |
|
2,215 |
1,211 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,623 |
1,621 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
165 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
381 |
351 |
$15K |
| D9430 |
|
157 |
156 |
$5K |
| D9993 |
|
72 |
72 |
$5K |
| D1310 |
|
72 |
72 |
$3K |
| D2330 |
|
42 |
25 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
89 |
89 |
$1K |
| D1999 |
|
89 |
86 |
$0.00 |