| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,474 |
5,240 |
$239K |
| D1120 |
Prophylaxis - child |
4,718 |
4,536 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,396 |
2,369 |
$140K |
| D0350 |
|
7,013 |
2,655 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
1,685 |
1,665 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,428 |
5,220 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,006 |
494 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,514 |
5,755 |
$55K |
| D0274 |
Bitewings - four radiographic images |
3,735 |
3,601 |
$55K |
| D1351 |
Sealant - per tooth |
1,197 |
277 |
$24K |
| D1110 |
Prophylaxis - adult |
361 |
360 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
108 |
56 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
283 |
169 |
$12K |
| D9430 |
|
296 |
287 |
$8K |
| D0272 |
Bitewings - two radiographic images |
779 |
751 |
$7K |
| D1320 |
|
292 |
290 |
$4K |
| D4341 |
|
33 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
577 |
497 |
$2K |
| D0330 |
Panoramic radiographic image |
158 |
156 |
$2K |
| D1206 |
Topical application of fluoride varnish |
129 |
129 |
$1K |
| D1310 |
|
44 |
44 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$1K |
| D9993 |
|
17 |
17 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D8670 |
Periodic orthodontic treatment visit |
13 |
13 |
$354.00 |
| D1330 |
|
445 |
374 |
$0.00 |