| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,094 |
1,992 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
3,265 |
3,056 |
$1K |
| D1120 |
Prophylaxis - child |
939 |
898 |
$791.45 |
| D1206 |
Topical application of fluoride varnish |
2,756 |
2,519 |
$783.08 |
| D1110 |
Prophylaxis - adult |
585 |
567 |
$715.29 |
| D0120 |
Periodic oral evaluation - established patient |
1,028 |
968 |
$416.06 |
| D1354 |
|
5,487 |
2,459 |
$380.53 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,697 |
1,507 |
$379.44 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
61 |
43 |
$360.00 |
| D0274 |
Bitewings - four radiographic images |
539 |
508 |
$304.40 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
302 |
165 |
$211.22 |
| D0272 |
Bitewings - two radiographic images |
383 |
357 |
$160.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
90 |
$114.00 |
| D0330 |
Panoramic radiographic image |
128 |
112 |
$50.42 |
| D0603 |
|
2,354 |
2,186 |
$11.00 |
| D1320 |
|
1,244 |
1,215 |
$10.00 |
| D0191 |
|
343 |
338 |
$0.00 |
| D9910 |
|
426 |
314 |
$0.00 |
| D1330 |
|
3,641 |
3,397 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
458 |
445 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
119 |
84 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
29 |
$0.00 |
| D0601 |
|
113 |
110 |
$0.00 |
| D0602 |
|
441 |
432 |
$0.00 |
| D1355 |
|
87 |
16 |
$0.00 |
| D1351 |
Sealant - per tooth |
180 |
60 |
$0.00 |