| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,465 |
5,438 |
$349K |
| D0210 |
Intraoral - complete series of radiographic images |
4,814 |
4,797 |
$221K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,270 |
417 |
$144K |
| D2740 |
Crown - porcelain/ceramic |
129 |
94 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
743 |
447 |
$49K |
| D4341 |
|
561 |
216 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
547 |
543 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
263 |
55 |
$15K |
| D1110 |
Prophylaxis - adult |
176 |
176 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
265 |
163 |
$14K |
| D1120 |
Prophylaxis - child |
335 |
331 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,074 |
1,265 |
$13K |
| D4910 |
|
188 |
188 |
$13K |
| D0274 |
Bitewings - four radiographic images |
652 |
648 |
$13K |
| D9430 |
|
356 |
349 |
$11K |
| D5130 |
|
15 |
15 |
$9K |
| D2330 |
|
81 |
52 |
$6K |
| D0330 |
Panoramic radiographic image |
687 |
683 |
$5K |
| D1206 |
Topical application of fluoride varnish |
314 |
313 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
228 |
227 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
137 |
135 |
$2K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$168.00 |
| D0270 |
|
13 |
13 |
$65.00 |
| D0140 |
Limited oral evaluation - problem focused |
33 |
31 |
$0.00 |