| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,050 |
4,993 |
$425K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,059 |
2,965 |
$346K |
| D0220 |
Intraoral - periapical first radiographic image |
12,314 |
11,582 |
$334K |
| D0140 |
Limited oral evaluation - problem focused |
4,571 |
4,223 |
$326K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,801 |
1,860 |
$314K |
| D1206 |
Topical application of fluoride varnish |
3,975 |
3,942 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,100 |
637 |
$99K |
| D1110 |
Prophylaxis - adult |
3,345 |
3,257 |
$92K |
| D0274 |
Bitewings - four radiographic images |
6,705 |
6,572 |
$83K |
| D2140 |
|
1,436 |
805 |
$79K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,729 |
961 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
797 |
492 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,521 |
8,208 |
$50K |
| D1120 |
Prophylaxis - child |
3,508 |
3,484 |
$49K |
| D2752 |
|
189 |
101 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
742 |
369 |
$41K |
| D0330 |
Panoramic radiographic image |
1,808 |
1,736 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
121 |
82 |
$13K |
| D2331 |
|
126 |
83 |
$9K |
| D2160 |
|
187 |
108 |
$8K |
| D2330 |
|
73 |
49 |
$5K |
| D2332 |
|
40 |
25 |
$4K |
| D0272 |
Bitewings - two radiographic images |
427 |
423 |
$3K |
| D1351 |
Sealant - per tooth |
143 |
19 |
$2K |
| D1999 |
|
35 |
26 |
$661.35 |
| D0431 |
|
99 |
99 |
$0.00 |