| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,112 |
4,081 |
$243K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,549 |
709 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
4,492 |
4,353 |
$183K |
| D0210 |
Intraoral - complete series of radiographic images |
3,717 |
3,683 |
$147K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,126 |
5,838 |
$89K |
| D1110 |
Prophylaxis - adult |
1,144 |
1,132 |
$80K |
| D1120 |
Prophylaxis - child |
2,489 |
2,396 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,117 |
574 |
$69K |
| D0274 |
Bitewings - four radiographic images |
4,418 |
4,377 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,029 |
2,937 |
$38K |
| D0350 |
|
4,224 |
1,224 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
626 |
346 |
$29K |
| D1320 |
|
731 |
726 |
$11K |
| D9430 |
|
395 |
384 |
$11K |
| D1351 |
Sealant - per tooth |
319 |
70 |
$8K |
| D0330 |
Panoramic radiographic image |
290 |
289 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,315 |
1,264 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
194 |
190 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$420.00 |
| D1310 |
|
53 |
53 |
$92.00 |
| D0601 |
|
27 |
27 |
$15.00 |
| D1330 |
|
24 |
24 |
$0.00 |