| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,079 |
8,055 |
$455K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,307 |
7,280 |
$451K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,768 |
2,447 |
$251K |
| D0210 |
Intraoral - complete series of radiographic images |
5,067 |
5,044 |
$236K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,404 |
9,801 |
$221K |
| D1120 |
Prophylaxis - child |
4,849 |
4,831 |
$188K |
| D0274 |
Bitewings - four radiographic images |
8,468 |
8,416 |
$175K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,439 |
805 |
$165K |
| D2140 |
|
2,879 |
1,856 |
$156K |
| D1110 |
Prophylaxis - adult |
1,757 |
1,746 |
$154K |
| D4341 |
|
1,352 |
575 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,638 |
7,610 |
$91K |
| D8670 |
Periodic orthodontic treatment visit |
318 |
318 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
692 |
228 |
$39K |
| D0350 |
|
3,821 |
2,469 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
513 |
513 |
$17K |
| D2160 |
|
161 |
135 |
$13K |
| D0330 |
Panoramic radiographic image |
596 |
594 |
$12K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
12 |
$7K |
| D0272 |
Bitewings - two radiographic images |
274 |
273 |
$3K |
| D1206 |
Topical application of fluoride varnish |
165 |
165 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
26 |
$2K |
| D4910 |
|
38 |
38 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
43 |
43 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
15 |
$1K |
| D9910 |
|
31 |
30 |
$903.00 |
| D1999 |
|
2,345 |
2,343 |
$667.00 |