| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,231 |
5,012 |
$253K |
| D1120 |
Prophylaxis - child |
5,908 |
5,535 |
$191K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,310 |
5,814 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,336 |
2,070 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,571 |
6,170 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
992 |
591 |
$64K |
| D0272 |
Bitewings - two radiographic images |
5,134 |
4,929 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
1,441 |
1,195 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
425 |
212 |
$21K |
| D1351 |
Sealant - per tooth |
1,162 |
279 |
$19K |
| D1110 |
Prophylaxis - adult |
273 |
251 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
353 |
217 |
$17K |
| D9430 |
|
440 |
377 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
13 |
$8K |
| D4910 |
|
99 |
99 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
521 |
481 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
72 |
45 |
$5K |
| D0274 |
Bitewings - four radiographic images |
232 |
229 |
$5K |
| D0330 |
Panoramic radiographic image |
70 |
70 |
$2K |
| D2952 |
|
18 |
12 |
$2K |
| D0350 |
|
290 |
119 |
$1K |
| D1999 |
|
101 |
101 |
$46.00 |