| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,106 |
7,000 |
$321K |
| D8670 |
Periodic orthodontic treatment visit |
634 |
634 |
$141K |
| D0210 |
Intraoral - complete series of radiographic images |
3,293 |
3,233 |
$132K |
| D1120 |
Prophylaxis - child |
4,261 |
4,198 |
$121K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
862 |
287 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,226 |
3,183 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,326 |
534 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,949 |
2,913 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,518 |
7,110 |
$49K |
| D1206 |
Topical application of fluoride varnish |
5,236 |
5,153 |
$45K |
| D7240 |
Removal of impacted tooth - completely bony |
156 |
64 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
498 |
239 |
$32K |
| D1110 |
Prophylaxis - adult |
531 |
525 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
347 |
152 |
$27K |
| D1351 |
Sealant - per tooth |
1,188 |
257 |
$25K |
| D9430 |
|
825 |
803 |
$24K |
| D9220 |
|
137 |
137 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
473 |
463 |
$16K |
| D0330 |
Panoramic radiographic image |
563 |
559 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,142 |
1,120 |
$11K |
| D9221 |
|
140 |
136 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
598 |
595 |
$6K |
| D2394 |
|
63 |
33 |
$5K |
| D7230 |
|
18 |
12 |
$3K |
| D9241 |
|
15 |
14 |
$649.00 |
| D0220 |
Intraoral - periapical first radiographic image |
66 |
65 |
$540.00 |
| D9910 |
|
54 |
14 |
$361.20 |
| D9242 |
|
15 |
14 |
$206.50 |