| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,443 |
1,379 |
$20K |
| D1120 |
Prophylaxis - child |
1,850 |
1,797 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
515 |
487 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,271 |
2,463 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,890 |
1,836 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
1,262 |
1,175 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,095 |
694 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
508 |
345 |
$2K |
| D9430 |
|
1,028 |
898 |
$2K |
| D0274 |
Bitewings - four radiographic images |
834 |
786 |
$1K |
| D1351 |
Sealant - per tooth |
1,111 |
403 |
$770.00 |
| D0272 |
Bitewings - two radiographic images |
738 |
707 |
$516.00 |
| D0220 |
Intraoral - periapical first radiographic image |
304 |
278 |
$440.00 |
| D0350 |
|
45 |
24 |
$360.00 |
| D9993 |
|
349 |
332 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
181 |
61 |
$0.00 |
| D0270 |
|
554 |
467 |
$0.00 |
| D0330 |
Panoramic radiographic image |
81 |
63 |
$0.00 |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$0.00 |
| D4341 |
|
31 |
12 |
$0.00 |
| D4921 |
|
83 |
26 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
897 |
428 |
$0.00 |
| D1330 |
|
2,703 |
2,462 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
108 |
76 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
96 |
83 |
$0.00 |
| D1310 |
|
349 |
331 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
67 |
$0.00 |
| D0603 |
|
86 |
84 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14 |
12 |
$0.00 |
| D0601 |
|
15 |
15 |
$0.00 |