| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
744 |
702 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
373 |
338 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,428 |
1,070 |
$2K |
| D1120 |
Prophylaxis - child |
585 |
569 |
$810.00 |
| D1206 |
Topical application of fluoride varnish |
658 |
644 |
$654.00 |
| D0120 |
Periodic oral evaluation - established patient |
536 |
507 |
$540.00 |
| D0274 |
Bitewings - four radiographic images |
404 |
388 |
$324.00 |
| D0603 |
|
17 |
15 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
213 |
194 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
321 |
207 |
$0.00 |
| D1330 |
|
1,181 |
1,066 |
$0.00 |
| D1310 |
|
172 |
169 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
98 |
75 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
28 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
23 |
19 |
$0.00 |
| D0601 |
|
15 |
15 |
$0.00 |
| D1351 |
Sealant - per tooth |
66 |
16 |
$0.00 |
| D9430 |
|
602 |
526 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
40 |
$0.00 |
| D1110 |
Prophylaxis - adult |
111 |
100 |
$0.00 |
| D9993 |
|
184 |
181 |
$0.00 |
| D0270 |
|
332 |
288 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
103 |
68 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
370 |
156 |
$0.00 |
| D0350 |
|
57 |
49 |
$0.00 |