| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,368 |
9,294 |
$418K |
| D0120 |
Periodic oral evaluation - established patient |
9,272 |
9,199 |
$207K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,065 |
7,616 |
$169K |
| D0220 |
Intraoral - periapical first radiographic image |
9,247 |
9,155 |
$98K |
| D0330 |
Panoramic radiographic image |
2,930 |
2,922 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,049 |
729 |
$56K |
| D4341 |
|
552 |
363 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,570 |
1,567 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
547 |
399 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
610 |
473 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,294 |
1,293 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,443 |
1,434 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
1,133 |
1,115 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
151 |
128 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
466 |
463 |
$7K |
| D1120 |
Prophylaxis - child |
160 |
157 |
$5K |
| D9945 |
|
21 |
21 |
$2K |
| D2331 |
|
35 |
12 |
$2K |
| D1999 |
|
128 |
127 |
$0.00 |
| D1310 |
|
25 |
25 |
$0.00 |