| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,510 |
1,486 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
414 |
411 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
647 |
639 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
2,137 |
2,085 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
947 |
932 |
$1K |
| D0274 |
Bitewings - four radiographic images |
862 |
847 |
$1K |
| D1120 |
Prophylaxis - child |
604 |
597 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,615 |
945 |
$778.95 |
| D1206 |
Topical application of fluoride varnish |
1,068 |
1,058 |
$768.21 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
310 |
259 |
$568.00 |
| D0330 |
Panoramic radiographic image |
321 |
317 |
$501.10 |
| D1110 |
Prophylaxis - adult |
412 |
406 |
$437.04 |
| D7140 |
Extraction, erupted tooth or exposed root |
331 |
130 |
$320.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
26 |
$252.00 |
| D0603 |
|
59 |
58 |
$187.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
139 |
108 |
$168.00 |
| D9310 |
|
159 |
156 |
$135.00 |
| D0270 |
|
201 |
197 |
$55.00 |
| D0601 |
|
26 |
25 |
$22.00 |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$0.00 |
| D1310 |
|
610 |
608 |
$0.00 |
| D1330 |
|
1,093 |
1,081 |
$0.00 |
| D1351 |
Sealant - per tooth |
88 |
46 |
$0.00 |
| D9995 |
|
73 |
73 |
$0.00 |
| D1320 |
|
16 |
16 |
$0.00 |
| D0191 |
|
117 |
117 |
$0.00 |
| D4921 |
|
32 |
13 |
$0.00 |