| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,802 |
5,785 |
$361K |
| D0120 |
Periodic oral evaluation - established patient |
6,267 |
6,250 |
$305K |
| D0210 |
Intraoral - complete series of radiographic images |
4,734 |
4,720 |
$221K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,287 |
8,020 |
$170K |
| D1110 |
Prophylaxis - adult |
1,749 |
1,741 |
$149K |
| D4341 |
|
2,040 |
777 |
$140K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,126 |
655 |
$132K |
| D0274 |
Bitewings - four radiographic images |
6,074 |
6,045 |
$127K |
| D8670 |
Periodic orthodontic treatment visit |
425 |
425 |
$117K |
| D1120 |
Prophylaxis - child |
3,101 |
3,093 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,557 |
4,541 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
749 |
439 |
$50K |
| D1351 |
Sealant - per tooth |
2,263 |
523 |
$49K |
| D4910 |
|
446 |
446 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
699 |
690 |
$23K |
| D2140 |
|
407 |
285 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
264 |
171 |
$18K |
| D4342 |
|
370 |
164 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
259 |
166 |
$14K |
| D0330 |
Panoramic radiographic image |
825 |
818 |
$13K |
| D0350 |
|
1,123 |
680 |
$10K |
| D1206 |
Topical application of fluoride varnish |
620 |
619 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
166 |
64 |
$9K |
| D0272 |
Bitewings - two radiographic images |
512 |
507 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
111 |
96 |
$4K |
| D9910 |
|
45 |
44 |
$3K |
| D2330 |
|
30 |
12 |
$2K |
| D9430 |
|
68 |
67 |
$2K |
| D2160 |
|
17 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$288.00 |
| D1999 |
|
96 |
96 |
$46.00 |
| D1330 |
|
107 |
107 |
$0.00 |