| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,668 |
2,656 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
634 |
228 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
727 |
715 |
$30K |
| D0330 |
Panoramic radiographic image |
2,573 |
2,557 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
270 |
270 |
$15K |
| D9310 |
|
133 |
133 |
$11K |
| D4341 |
|
407 |
105 |
$9K |
| D2335 |
|
242 |
54 |
$7K |
| D1330 |
|
1,082 |
1,032 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
127 |
65 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,235 |
2,870 |
$5K |
| D8660 |
|
151 |
151 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
788 |
781 |
$3K |
| D1120 |
Prophylaxis - child |
462 |
459 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
69 |
30 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
3,232 |
3,202 |
$2K |
| D0272 |
Bitewings - two radiographic images |
1,123 |
1,110 |
$2K |
| D2332 |
|
30 |
14 |
$2K |
| D1110 |
Prophylaxis - adult |
129 |
127 |
$971.06 |
| D0274 |
Bitewings - four radiographic images |
1,386 |
1,381 |
$964.07 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
16 |
$878.90 |
| D1206 |
Topical application of fluoride varnish |
210 |
138 |
$697.44 |
| D0140 |
Limited oral evaluation - problem focused |
29 |
29 |
$454.19 |
| D1351 |
Sealant - per tooth |
56 |
15 |
$0.00 |
| D0340 |
|
121 |
121 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
26 |
$0.00 |