| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,014 |
10,010 |
$375K |
| D0120 |
Periodic oral evaluation - established patient |
9,596 |
9,586 |
$194K |
| D0210 |
Intraoral - complete series of radiographic images |
4,298 |
4,281 |
$131K |
| D0220 |
Intraoral - periapical first radiographic image |
11,357 |
11,265 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,508 |
4,507 |
$98K |
| D0274 |
Bitewings - four radiographic images |
4,076 |
4,075 |
$88K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,337 |
1,075 |
$78K |
| D9310 |
|
1,603 |
1,599 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,575 |
9,452 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
792 |
645 |
$53K |
| D1120 |
Prophylaxis - child |
1,798 |
1,796 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,607 |
2,606 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
465 |
351 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
474 |
380 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,814 |
1,812 |
$20K |
| D1351 |
Sealant - per tooth |
103 |
98 |
$14K |
| D4341 |
|
160 |
130 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
844 |
839 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
62 |
$5K |
| D9110 |
|
378 |
374 |
$5K |
| D0330 |
Panoramic radiographic image |
172 |
172 |
$4K |
| D2954 |
|
16 |
16 |
$2K |
| D2140 |
|
13 |
12 |
$700.00 |
| D1999 |
|
163 |
155 |
$0.00 |