| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,472 |
17,195 |
$556K |
| D1110 |
Prophylaxis - adult |
14,594 |
14,330 |
$392K |
| D0330 |
Panoramic radiographic image |
8,241 |
8,075 |
$361K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,140 |
5,538 |
$326K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,093 |
3,379 |
$257K |
| D0220 |
Intraoral - periapical first radiographic image |
21,252 |
20,864 |
$173K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,286 |
8,132 |
$152K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,319 |
3,429 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,738 |
22,321 |
$68K |
| D9920 |
|
1,442 |
1,415 |
$60K |
| D1120 |
Prophylaxis - child |
5,329 |
5,240 |
$36K |
| D1351 |
Sealant - per tooth |
10,034 |
2,518 |
$35K |
| D0274 |
Bitewings - four radiographic images |
13,284 |
13,062 |
$35K |
| D0272 |
Bitewings - two radiographic images |
3,688 |
3,611 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,798 |
17,436 |
$11K |
| D2332 |
|
289 |
203 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
73 |
42 |
$9K |
| D1330 |
|
22,916 |
22,503 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
271 |
154 |
$9K |
| D4341 |
|
373 |
161 |
$6K |
| D2335 |
|
47 |
31 |
$4K |
| D2331 |
|
86 |
63 |
$2K |
| D2330 |
|
69 |
42 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
26 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
24 |
24 |
$600.00 |
| D4355 |
|
18 |
17 |
$443.88 |
| D3120 |
|
69 |
41 |
$0.00 |