| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,800 |
3,728 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,498 |
3,412 |
$88K |
| D1110 |
Prophylaxis - adult |
3,652 |
3,570 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,578 |
937 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
2,012 |
1,967 |
$56K |
| D1120 |
Prophylaxis - child |
2,431 |
2,370 |
$46K |
| D9920 |
|
1,167 |
1,144 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
4,870 |
4,770 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,200 |
2,141 |
$18K |
| D0274 |
Bitewings - four radiographic images |
2,234 |
2,194 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,935 |
3,887 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
433 |
266 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
750 |
733 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
93 |
66 |
$4K |
| D0272 |
Bitewings - two radiographic images |
927 |
897 |
$4K |
| D0602 |
|
370 |
364 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
38 |
$2K |
| D0603 |
|
170 |
169 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
12 |
$810.00 |
| D0601 |
|
41 |
41 |
$380.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$189.00 |
| D1999 |
|
880 |
840 |
$0.00 |
| D1330 |
|
4,304 |
4,158 |
$0.00 |