| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,568 |
2,533 |
$974K |
| D1110 |
Prophylaxis - adult |
1,440 |
1,399 |
$570K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,679 |
851 |
$494K |
| D0140 |
Limited oral evaluation - problem focused |
2,075 |
1,965 |
$479K |
| D0330 |
Panoramic radiographic image |
1,334 |
1,307 |
$383K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,597 |
1,556 |
$331K |
| D1120 |
Prophylaxis - child |
1,048 |
1,025 |
$328K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
548 |
387 |
$267K |
| D0274 |
Bitewings - four radiographic images |
2,674 |
2,624 |
$198K |
| D4355 |
|
338 |
329 |
$149K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
276 |
184 |
$88K |
| D1206 |
Topical application of fluoride varnish |
3,186 |
3,099 |
$85K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
247 |
175 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,448 |
4,216 |
$42K |
| D2140 |
|
124 |
80 |
$24K |
| D0272 |
Bitewings - two radiographic images |
158 |
153 |
$22K |
| D1351 |
Sealant - per tooth |
255 |
65 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
6,673 |
6,265 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$11K |
| D9110 |
|
16 |
13 |
$6K |
| D1330 |
|
4,501 |
4,344 |
$519.00 |