| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,649 |
5,207 |
$126K |
| D1120 |
Prophylaxis - child |
2,963 |
2,798 |
$122K |
| D1110 |
Prophylaxis - adult |
4,436 |
3,894 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,454 |
5,864 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
5,180 |
4,486 |
$120K |
| D0210 |
Intraoral - complete series of radiographic images |
2,283 |
1,970 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,493 |
794 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,602 |
2,068 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,946 |
2,646 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
4,562 |
4,007 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
582 |
273 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
531 |
257 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
922 |
581 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
122 |
74 |
$7K |
| D2140 |
|
69 |
39 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
96 |
93 |
$3K |
| D2950 |
|
69 |
27 |
$2K |
| D2330 |
|
20 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
62 |
59 |
$1K |
| D0270 |
|
29 |
25 |
$172.20 |
| D1320 |
|
23 |
12 |
$10.14 |
| D1999 |
|
28 |
18 |
$0.00 |