| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,727 |
9,689 |
$548K |
| D1120 |
Prophylaxis - child |
11,313 |
11,270 |
$432K |
| D1351 |
Sealant - per tooth |
9,876 |
2,034 |
$275K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,252 |
2,140 |
$215K |
| D0230 |
Intraoral - periapical each additional radiographic image |
54,020 |
9,177 |
$214K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,107 |
1,993 |
$168K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,590 |
2,589 |
$164K |
| D0274 |
Bitewings - four radiographic images |
7,432 |
7,400 |
$157K |
| D0210 |
Intraoral - complete series of radiographic images |
2,737 |
2,730 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,143 |
11,101 |
$115K |
| D0330 |
Panoramic radiographic image |
2,872 |
2,859 |
$85K |
| D0350 |
|
7,637 |
3,746 |
$73K |
| D1110 |
Prophylaxis - adult |
165 |
165 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,181 |
1,180 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
228 |
118 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
555 |
529 |
$6K |
| D1206 |
Topical application of fluoride varnish |
373 |
373 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
37 |
$4K |
| D9430 |
|
25 |
25 |
$800.00 |
| D1310 |
|
40 |
40 |
$0.00 |