| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,021 |
2,953 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,773 |
2,711 |
$14K |
| D1110 |
Prophylaxis - adult |
2,276 |
2,208 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
1,071 |
1,040 |
$9K |
| D1120 |
Prophylaxis - child |
1,302 |
1,261 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
681 |
409 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
446 |
434 |
$4K |
| D9920 |
|
655 |
630 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,228 |
1,190 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
3,764 |
3,695 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,105 |
1,073 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,202 |
3,052 |
$2K |
| D0272 |
Bitewings - two radiographic images |
349 |
341 |
$710.00 |
| D0602 |
|
151 |
141 |
$630.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$494.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
125 |
$494.00 |
| D0601 |
|
146 |
143 |
$350.00 |
| D1330 |
|
2,487 |
2,354 |
$0.00 |
| D0603 |
|
37 |
37 |
$0.00 |
| D1999 |
|
336 |
311 |
$0.00 |
| D0270 |
|
12 |
12 |
$0.00 |