| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,028 |
4,003 |
$264K |
| D0210 |
Intraoral - complete series of radiographic images |
3,303 |
3,285 |
$155K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,145 |
965 |
$141K |
| D1110 |
Prophylaxis - adult |
1,572 |
1,562 |
$130K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
724 |
424 |
$78K |
| D1120 |
Prophylaxis - child |
1,814 |
1,801 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
788 |
418 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
801 |
785 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,630 |
2,575 |
$53K |
| D9430 |
|
1,619 |
1,565 |
$51K |
| D4341 |
|
686 |
179 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,416 |
3,393 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
698 |
362 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
819 |
543 |
$32K |
| D1351 |
Sealant - per tooth |
688 |
185 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
287 |
117 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,422 |
1,394 |
$17K |
| D0340 |
|
189 |
187 |
$9K |
| D0272 |
Bitewings - two radiographic images |
670 |
664 |
$8K |
| D0274 |
Bitewings - four radiographic images |
360 |
357 |
$7K |
| D0330 |
Panoramic radiographic image |
228 |
226 |
$7K |
| D7111 |
|
47 |
27 |
$3K |
| D0350 |
|
223 |
151 |
$2K |
| D4342 |
|
43 |
12 |
$2K |
| D2160 |
|
19 |
13 |
$2K |
| D4910 |
|
28 |
26 |
$1K |
| D1310 |
|
13 |
13 |
$0.00 |