| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,672 |
2,602 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
2,290 |
2,217 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,339 |
3,454 |
$15K |
| D1206 |
Topical application of fluoride varnish |
2,344 |
2,271 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
935 |
869 |
$4K |
| D0274 |
Bitewings - four radiographic images |
1,789 |
1,728 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
694 |
460 |
$1K |
| D0272 |
Bitewings - two radiographic images |
538 |
507 |
$876.00 |
| D0210 |
Intraoral - complete series of radiographic images |
352 |
312 |
$576.00 |
| D0220 |
Intraoral - periapical first radiographic image |
370 |
328 |
$468.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
774 |
452 |
$0.00 |
| D9430 |
|
1,058 |
894 |
$0.00 |
| D0270 |
|
432 |
365 |
$0.00 |
| D2332 |
|
32 |
18 |
$0.00 |
| D1110 |
Prophylaxis - adult |
77 |
70 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
407 |
180 |
$0.00 |
| D0330 |
Panoramic radiographic image |
407 |
343 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
430 |
300 |
$0.00 |
| D9993 |
|
553 |
541 |
$0.00 |
| D1510 |
|
38 |
29 |
$0.00 |
| D2140 |
|
25 |
16 |
$0.00 |
| D1310 |
|
555 |
541 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
525 |
343 |
$0.00 |
| D1330 |
|
4,951 |
4,404 |
$0.00 |
| D0603 |
|
323 |
318 |
$0.00 |
| D1351 |
Sealant - per tooth |
943 |
300 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
60 |
48 |
$0.00 |
| D2160 |
|
57 |
46 |
$0.00 |
| D7250 |
|
20 |
12 |
$0.00 |
| D0602 |
|
56 |
56 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
192 |
138 |
$0.00 |
| D7230 |
|
34 |
25 |
$0.00 |