| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
4,760 |
4,516 |
$885K |
| D0120 |
Periodic oral evaluation - established patient |
2,987 |
2,967 |
$714K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,157 |
1,543 |
$310K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,049 |
2,016 |
$305K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,754 |
1,286 |
$251K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
114 |
92 |
$18K |
| D5899 |
|
57 |
37 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
264 |
110 |
$17K |
| D1110 |
Prophylaxis - adult |
2,936 |
2,899 |
$1K |
| D2330 |
|
15 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
5,136 |
5,055 |
$1K |
| D0274 |
Bitewings - four radiographic images |
1,546 |
1,525 |
$105.21 |
| D0220 |
Intraoral - periapical first radiographic image |
3,886 |
3,785 |
$52.54 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,416 |
2,665 |
$34.90 |
| D0272 |
Bitewings - two radiographic images |
757 |
745 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
990 |
979 |
$0.00 |
| D1351 |
Sealant - per tooth |
383 |
128 |
$0.00 |
| D1120 |
Prophylaxis - child |
2,103 |
2,084 |
$0.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$0.00 |