| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,563 |
6,278 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,026 |
5,830 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,518 |
2,310 |
$104K |
| D2750 |
|
464 |
371 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
4,409 |
4,264 |
$94K |
| D1110 |
Prophylaxis - adult |
5,237 |
5,055 |
$82K |
| D1120 |
Prophylaxis - child |
4,561 |
4,365 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,737 |
1,199 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
2,925 |
2,708 |
$42K |
| D4341 |
|
1,307 |
560 |
$35K |
| D0274 |
Bitewings - four radiographic images |
3,937 |
3,738 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,796 |
3,620 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
7,680 |
7,229 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,823 |
5,855 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
463 |
341 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
395 |
243 |
$10K |
| D3320 |
|
45 |
38 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
199 |
97 |
$6K |
| D2954 |
|
240 |
188 |
$6K |
| D0272 |
Bitewings - two radiographic images |
1,429 |
1,393 |
$5K |
| D2950 |
|
80 |
66 |
$4K |
| D1351 |
Sealant - per tooth |
141 |
30 |
$869.00 |
| D2330 |
|
22 |
14 |
$570.00 |
| D2335 |
|
15 |
12 |
$420.00 |
| D0270 |
|
173 |
165 |
$363.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$298.35 |
| D9986 |
|
455 |
399 |
$0.00 |
| D1330 |
|
1,183 |
1,082 |
$0.00 |