| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,715 |
3,688 |
$152K |
| D0330 |
Panoramic radiographic image |
2,629 |
2,615 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,002 |
1,526 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,274 |
1,221 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,855 |
2,836 |
$36K |
| D1110 |
Prophylaxis - adult |
3,421 |
3,392 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
310 |
242 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
406 |
402 |
$29K |
| D1120 |
Prophylaxis - child |
2,579 |
2,565 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,864 |
5,816 |
$12K |
| D1330 |
|
6,040 |
5,986 |
$10K |
| D1351 |
Sealant - per tooth |
2,574 |
489 |
$10K |
| D4341 |
|
456 |
149 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
109 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
958 |
929 |
$8K |
| D2332 |
|
115 |
72 |
$6K |
| D0274 |
Bitewings - four radiographic images |
3,292 |
3,265 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
4,902 |
4,854 |
$3K |
| D0272 |
Bitewings - two radiographic images |
1,431 |
1,422 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,575 |
4,536 |
$2K |
| D2335 |
|
16 |
13 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
107 |
99 |
$998.45 |
| D2330 |
|
20 |
14 |
$853.81 |
| D1999 |
|
104 |
96 |
$0.00 |