| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,472 |
3,462 |
$220K |
| D0210 |
Intraoral - complete series of radiographic images |
3,597 |
3,587 |
$169K |
| D8670 |
Periodic orthodontic treatment visit |
522 |
521 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,581 |
964 |
$106K |
| D4341 |
|
1,409 |
494 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
1,655 |
1,647 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,448 |
3,038 |
$61K |
| D0330 |
Panoramic radiographic image |
2,383 |
2,377 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,308 |
2,274 |
$47K |
| D1120 |
Prophylaxis - child |
1,353 |
1,349 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
748 |
470 |
$41K |
| D1110 |
Prophylaxis - adult |
269 |
268 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
170 |
83 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,449 |
1,449 |
$15K |
| D4342 |
|
325 |
117 |
$14K |
| D4910 |
|
171 |
171 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
314 |
314 |
$11K |
| D1206 |
Topical application of fluoride varnish |
535 |
531 |
$8K |
| D0350 |
|
794 |
425 |
$7K |
| D9430 |
|
88 |
87 |
$3K |
| D9222 |
|
13 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$1K |
| D1351 |
Sealant - per tooth |
62 |
13 |
$1K |
| D9910 |
|
107 |
14 |
$120.40 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$120.00 |
| D0270 |
|
14 |
14 |
$65.00 |