| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,390 |
3,378 |
$211K |
| D0210 |
Intraoral - complete series of radiographic images |
2,843 |
2,830 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
2,273 |
2,262 |
$115K |
| D4341 |
|
1,298 |
474 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,500 |
3,387 |
$69K |
| D1110 |
Prophylaxis - adult |
888 |
887 |
$65K |
| D1120 |
Prophylaxis - child |
1,586 |
1,579 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
490 |
257 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,237 |
2,223 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
498 |
293 |
$33K |
| D4910 |
|
410 |
410 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,352 |
2,340 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
347 |
195 |
$19K |
| D1351 |
Sealant - per tooth |
563 |
125 |
$10K |
| D0330 |
Panoramic radiographic image |
326 |
326 |
$7K |
| D0350 |
|
694 |
360 |
$6K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
24 |
13 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
56 |
34 |
$4K |
| D9910 |
|
86 |
86 |
$3K |
| D9430 |
|
84 |
84 |
$3K |
| D4342 |
|
59 |
25 |
$2K |
| D1206 |
Topical application of fluoride varnish |
151 |
151 |
$2K |
| D9222 |
|
13 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$770.00 |
| D0272 |
Bitewings - two radiographic images |
30 |
30 |
$348.00 |
| D1330 |
|
36 |
36 |
$0.00 |