| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,122 |
3,559 |
$75K |
| D1110 |
Prophylaxis - adult |
3,407 |
3,032 |
$62K |
| D1120 |
Prophylaxis - child |
2,233 |
1,940 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,639 |
1,542 |
$32K |
| D0330 |
Panoramic radiographic image |
609 |
562 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
746 |
361 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
463 |
203 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
336 |
334 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
567 |
513 |
$9K |
| D1351 |
Sealant - per tooth |
2,107 |
398 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,797 |
5,133 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
5,333 |
4,673 |
$5K |
| D1330 |
|
5,917 |
5,250 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,891 |
4,222 |
$2K |
| D0274 |
Bitewings - four radiographic images |
2,942 |
2,568 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
148 |
74 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
16 |
$496.91 |
| D0272 |
Bitewings - two radiographic images |
1,617 |
1,402 |
$431.04 |
| D2331 |
|
21 |
13 |
$396.46 |
| D9248 |
|
15 |
15 |
$298.29 |
| D0601 |
|
49 |
49 |
$75.00 |
| D3120 |
|
404 |
174 |
$31.35 |
| D0270 |
|
12 |
12 |
$29.98 |