| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,343 |
5,329 |
$332K |
| D0120 |
Periodic oral evaluation - established patient |
4,906 |
4,896 |
$283K |
| D1120 |
Prophylaxis - child |
4,942 |
4,933 |
$191K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,822 |
1,647 |
$189K |
| D0210 |
Intraoral - complete series of radiographic images |
4,043 |
4,027 |
$188K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,526 |
746 |
$181K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,380 |
6,897 |
$142K |
| D1351 |
Sealant - per tooth |
4,527 |
1,180 |
$125K |
| D1110 |
Prophylaxis - adult |
1,295 |
1,295 |
$102K |
| D2140 |
|
1,679 |
1,059 |
$91K |
| D0274 |
Bitewings - four radiographic images |
4,252 |
4,237 |
$88K |
| D4341 |
|
1,161 |
369 |
$79K |
| D1206 |
Topical application of fluoride varnish |
5,143 |
5,120 |
$74K |
| D8670 |
Periodic orthodontic treatment visit |
111 |
111 |
$33K |
| D0350 |
|
3,172 |
1,941 |
$31K |
| D4910 |
|
338 |
337 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,014 |
2,012 |
$20K |
| D1310 |
|
399 |
399 |
$18K |
| D9910 |
|
269 |
266 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,238 |
1,234 |
$15K |
| D9993 |
|
220 |
220 |
$14K |
| D2160 |
|
159 |
115 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
193 |
64 |
$11K |
| D0330 |
Panoramic radiographic image |
907 |
902 |
$9K |
| D4342 |
|
190 |
80 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
12 |
12 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
51 |
$5K |
| D2954 |
|
40 |
37 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
103 |
101 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
83 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
19 |
$2K |
| D9430 |
|
20 |
19 |
$640.00 |
| D0601 |
|
25 |
25 |
$360.00 |
| D0602 |
|
12 |
12 |
$180.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$156.00 |
| D1330 |
|
3,139 |
3,126 |
$0.00 |