| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,736 |
3,995 |
$104K |
| D1120 |
Prophylaxis - child |
2,600 |
2,253 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,188 |
545 |
$85K |
| D1110 |
Prophylaxis - adult |
2,537 |
2,073 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,638 |
2,161 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,618 |
2,300 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
2,071 |
1,787 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
567 |
223 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
908 |
368 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
932 |
759 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,736 |
1,493 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
366 |
128 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
303 |
145 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
247 |
229 |
$14K |
| D0330 |
Panoramic radiographic image |
411 |
367 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
891 |
603 |
$9K |
| D2394 |
|
49 |
37 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
88 |
56 |
$5K |
| D3110 |
|
50 |
26 |
$4K |
| D1351 |
Sealant - per tooth |
105 |
24 |
$3K |
| D2140 |
|
39 |
26 |
$2K |
| D2332 |
|
20 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
32 |
25 |
$710.40 |
| D1310 |
|
226 |
221 |
$0.00 |
| D1330 |
|
226 |
221 |
$0.00 |