| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,960 |
5,952 |
$377K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,284 |
2,555 |
$288K |
| D0210 |
Intraoral - complete series of radiographic images |
5,492 |
5,477 |
$258K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,501 |
1,980 |
$235K |
| D1110 |
Prophylaxis - adult |
2,495 |
2,489 |
$208K |
| D0120 |
Periodic oral evaluation - established patient |
2,685 |
2,674 |
$135K |
| D4341 |
|
1,307 |
513 |
$91K |
| D8670 |
Periodic orthodontic treatment visit |
322 |
321 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,875 |
3,678 |
$76K |
| D0274 |
Bitewings - four radiographic images |
3,093 |
3,042 |
$62K |
| D0350 |
|
6,058 |
2,780 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
439 |
216 |
$52K |
| D1120 |
Prophylaxis - child |
1,095 |
1,093 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,701 |
1,692 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,504 |
1,503 |
$19K |
| D0330 |
Panoramic radiographic image |
1,046 |
1,042 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
425 |
424 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
211 |
125 |
$14K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
50 |
28 |
$9K |
| D9910 |
|
166 |
166 |
$8K |
| D2140 |
|
118 |
58 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
77 |
59 |
$6K |
| D4910 |
|
79 |
79 |
$6K |
| D4342 |
|
126 |
51 |
$5K |
| D2160 |
|
42 |
32 |
$3K |
| D9222 |
|
29 |
29 |
$3K |
| D1351 |
Sealant - per tooth |
126 |
31 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$120.00 |
| D0270 |
|
12 |
12 |
$60.00 |
| D1330 |
|
126 |
126 |
$0.00 |