| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
3,055 |
2,728 |
$992K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
812 |
771 |
$285K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
543 |
432 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
367 |
363 |
$138K |
| D7140 |
Extraction, erupted tooth or exposed root |
444 |
303 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
175 |
$74K |
| D9110 |
|
57 |
55 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
32 |
28 |
$3K |
| D2940 |
|
15 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
1,107 |
1,009 |
$282.64 |
| D1110 |
Prophylaxis - adult |
630 |
599 |
$162.76 |
| D1206 |
Topical application of fluoride varnish |
1,075 |
1,020 |
$58.21 |
| D0220 |
Intraoral - periapical first radiographic image |
2,059 |
1,885 |
$53.55 |
| D0274 |
Bitewings - four radiographic images |
942 |
875 |
$32.29 |
| D0230 |
Intraoral - periapical each additional radiographic image |
770 |
449 |
$16.06 |
| D0270 |
|
222 |
211 |
$13.29 |
| D0272 |
Bitewings - two radiographic images |
102 |
99 |
$0.00 |
| D4355 |
|
17 |
17 |
$0.00 |
| D1120 |
Prophylaxis - child |
419 |
416 |
$0.00 |