| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,893 |
12,872 |
$813K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,297 |
3,395 |
$745K |
| D0120 |
Periodic oral evaluation - established patient |
12,056 |
12,025 |
$656K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,718 |
5,559 |
$584K |
| D0210 |
Intraoral - complete series of radiographic images |
12,203 |
12,181 |
$572K |
| D8670 |
Periodic orthodontic treatment visit |
1,866 |
1,866 |
$504K |
| D1120 |
Prophylaxis - child |
10,424 |
10,418 |
$427K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,854 |
14,648 |
$336K |
| D2140 |
|
5,198 |
3,486 |
$282K |
| D0274 |
Bitewings - four radiographic images |
13,025 |
12,985 |
$273K |
| D4341 |
|
3,644 |
1,527 |
$253K |
| D1110 |
Prophylaxis - adult |
2,996 |
2,996 |
$244K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,698 |
1,129 |
$211K |
| D2160 |
|
2,386 |
1,811 |
$190K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,447 |
13,441 |
$160K |
| D0330 |
Panoramic radiographic image |
4,645 |
4,633 |
$126K |
| D0350 |
|
7,375 |
4,343 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,827 |
1,815 |
$62K |
| D4910 |
|
792 |
792 |
$60K |
| D2330 |
|
717 |
433 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
933 |
625 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
506 |
372 |
$34K |
| D9910 |
|
306 |
271 |
$11K |
| D1310 |
|
232 |
230 |
$10K |
| D2331 |
|
118 |
103 |
$9K |
| D0272 |
Bitewings - two radiographic images |
594 |
593 |
$7K |
| D1206 |
Topical application of fluoride varnish |
238 |
238 |
$6K |
| D4342 |
|
117 |
56 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
299 |
299 |
$4K |
| D2332 |
|
33 |
28 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
32 |
$1K |
| D0602 |
|
77 |
77 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$826.00 |
| D0601 |
|
27 |
27 |
$405.00 |