| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,417 |
9,218 |
$215K |
| D1120 |
Prophylaxis - child |
6,663 |
6,493 |
$210K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,863 |
9,647 |
$190K |
| D1110 |
Prophylaxis - adult |
4,477 |
4,391 |
$180K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,481 |
1,460 |
$163K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,341 |
1,494 |
$132K |
| D0274 |
Bitewings - four radiographic images |
4,066 |
3,983 |
$104K |
| D0330 |
Panoramic radiographic image |
2,504 |
2,430 |
$85K |
| D0272 |
Bitewings - two radiographic images |
2,917 |
2,837 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,473 |
1,428 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
302 |
203 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,436 |
1,393 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
238 |
135 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
14 |
$7K |
| D2950 |
|
17 |
14 |
$2K |
| D9110 |
|
40 |
40 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
71 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48 |
38 |
$433.89 |
| D1999 |
|
66 |
66 |
$0.00 |