| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,462 |
2,432 |
$82K |
| D0330 |
Panoramic radiographic image |
2,815 |
2,783 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
899 |
882 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,064 |
573 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
571 |
288 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
245 |
140 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
71 |
$8K |
| D1330 |
|
3,288 |
3,236 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
602 |
579 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,524 |
1,502 |
$4K |
| D0272 |
Bitewings - two radiographic images |
3,180 |
3,139 |
$3K |
| D4355 |
|
119 |
117 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
3,592 |
3,531 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
28 |
$3K |
| D9310 |
|
138 |
138 |
$3K |
| D1110 |
Prophylaxis - adult |
420 |
416 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,316 |
3,259 |
$1K |
| D1351 |
Sealant - per tooth |
397 |
85 |
$572.39 |
| D0603 |
|
2,420 |
2,375 |
$467.24 |
| D1120 |
Prophylaxis - child |
430 |
418 |
$459.14 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$42.90 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$41.80 |