| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,562 |
5,478 |
$145K |
| D1110 |
Prophylaxis - adult |
2,928 |
2,882 |
$139K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,023 |
5,938 |
$118K |
| D0210 |
Intraoral - complete series of radiographic images |
1,223 |
1,191 |
$96K |
| D1120 |
Prophylaxis - child |
2,631 |
2,593 |
$92K |
| D0272 |
Bitewings - two radiographic images |
3,698 |
3,647 |
$75K |
| D1351 |
Sealant - per tooth |
2,174 |
729 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
695 |
351 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
556 |
283 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,189 |
2,127 |
$37K |
| D2140 |
|
583 |
307 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
754 |
740 |
$24K |
| D0330 |
Panoramic radiographic image |
862 |
857 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
238 |
137 |
$19K |
| D0603 |
|
3,650 |
3,603 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
442 |
440 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
80 |
$9K |
| D4341 |
|
64 |
29 |
$8K |
| D0601 |
|
1,220 |
1,196 |
$5K |
| D0602 |
|
1,252 |
1,231 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
13 |
$2K |
| D1354 |
|
147 |
39 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
15 |
$205.40 |
| D0251 |
|
95 |
94 |
$0.00 |
| D9986 |
|
117 |
115 |
$0.00 |