| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,676 |
4,649 |
$186K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,807 |
1,796 |
$103K |
| D0210 |
Intraoral - complete series of radiographic images |
1,109 |
1,102 |
$67K |
| D1110 |
Prophylaxis - adult |
3,950 |
3,930 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,007 |
1,341 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
615 |
474 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,280 |
1,271 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
450 |
299 |
$18K |
| D0330 |
Panoramic radiographic image |
539 |
538 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,734 |
3,107 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
1,229 |
1,208 |
$11K |
| D1120 |
Prophylaxis - child |
1,981 |
1,972 |
$10K |
| D2331 |
|
211 |
146 |
$7K |
| D1206 |
Topical application of fluoride varnish |
3,720 |
3,700 |
$7K |
| D1330 |
|
6,013 |
5,983 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
3,781 |
3,745 |
$2K |
| D0274 |
Bitewings - four radiographic images |
2,122 |
2,108 |
$2K |
| D2330 |
|
46 |
30 |
$1K |
| D1351 |
Sealant - per tooth |
258 |
67 |
$912.00 |
| D7111 |
|
16 |
13 |
$360.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
14 |
$350.00 |
| D0272 |
Bitewings - two radiographic images |
56 |
56 |
$17.00 |
| D9986 |
|
90 |
85 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |