| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,522 |
7,489 |
$467K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,371 |
1,541 |
$398K |
| D0120 |
Periodic oral evaluation - established patient |
4,858 |
4,825 |
$260K |
| D1120 |
Prophylaxis - child |
4,983 |
4,961 |
$178K |
| D0210 |
Intraoral - complete series of radiographic images |
3,634 |
3,619 |
$171K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,181 |
7,887 |
$162K |
| D4341 |
|
1,754 |
673 |
$121K |
| D0274 |
Bitewings - four radiographic images |
3,920 |
3,880 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
850 |
559 |
$57K |
| D1110 |
Prophylaxis - adult |
710 |
708 |
$57K |
| D8670 |
Periodic orthodontic treatment visit |
186 |
186 |
$53K |
| D1206 |
Topical application of fluoride varnish |
3,704 |
3,676 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
560 |
340 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
491 |
166 |
$28K |
| D4342 |
|
685 |
267 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,092 |
2,075 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,144 |
2,141 |
$21K |
| D1310 |
|
433 |
433 |
$20K |
| D9430 |
|
518 |
517 |
$16K |
| D9993 |
|
257 |
257 |
$16K |
| D1351 |
Sealant - per tooth |
503 |
112 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
215 |
150 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
392 |
387 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
316 |
306 |
$12K |
| D0350 |
|
1,360 |
718 |
$12K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
43 |
25 |
$8K |
| D0330 |
Panoramic radiographic image |
240 |
234 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
56 |
42 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
317 |
317 |
$4K |
| D2160 |
|
43 |
30 |
$3K |
| D4910 |
|
41 |
41 |
$3K |
| D9222 |
|
24 |
24 |
$3K |
| D9910 |
|
148 |
147 |
$3K |
| D2140 |
|
47 |
28 |
$3K |
| D0603 |
|
64 |
64 |
$945.00 |
| D0270 |
|
64 |
64 |
$305.00 |
| D0602 |
|
12 |
12 |
$180.00 |
| D1999 |
|
18 |
18 |
$0.00 |
| D1330 |
|
1,293 |
1,287 |
$0.00 |