| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,293 |
12,929 |
$335K |
| D1110 |
Prophylaxis - adult |
8,655 |
8,425 |
$325K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,310 |
1,598 |
$245K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,147 |
1,895 |
$194K |
| D0220 |
Intraoral - periapical first radiographic image |
11,794 |
11,166 |
$174K |
| D0140 |
Limited oral evaluation - problem focused |
3,948 |
3,725 |
$136K |
| D1206 |
Topical application of fluoride varnish |
7,299 |
7,138 |
$117K |
| D0274 |
Bitewings - four radiographic images |
3,837 |
3,728 |
$115K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,518 |
8,144 |
$114K |
| D1120 |
Prophylaxis - child |
3,508 |
3,433 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
283 |
208 |
$36K |
| D0330 |
Panoramic radiographic image |
556 |
545 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
374 |
278 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,447 |
1,425 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
391 |
380 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
150 |
124 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
38 |
$6K |
| D2140 |
|
48 |
38 |
$3K |
| D2335 |
|
24 |
15 |
$3K |
| D2160 |
|
15 |
13 |
$2K |
| D2331 |
|
14 |
12 |
$1K |
| D0707 |
|
26 |
26 |
$0.00 |