| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,188 |
9,161 |
$215K |
| D0120 |
Periodic oral evaluation - established patient |
8,430 |
8,408 |
$198K |
| D0210 |
Intraoral - complete series of radiographic images |
3,560 |
3,544 |
$125K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,748 |
946 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,613 |
3,603 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,981 |
982 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,618 |
1,051 |
$75K |
| D1120 |
Prophylaxis - child |
2,527 |
2,518 |
$73K |
| D0274 |
Bitewings - four radiographic images |
5,567 |
5,552 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
3,034 |
3,009 |
$69K |
| D2750 |
|
131 |
93 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
8,868 |
8,817 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,263 |
7,583 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,441 |
2,434 |
$29K |
| D1351 |
Sealant - per tooth |
1,397 |
211 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
395 |
179 |
$18K |
| D2335 |
|
267 |
105 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
222 |
169 |
$12K |
| D2954 |
|
109 |
98 |
$10K |
| D2332 |
|
70 |
27 |
$4K |
| D2330 |
|
40 |
14 |
$2K |
| D4341 |
|
32 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
43 |
40 |
$930.00 |
| D9310 |
|
14 |
14 |
$252.00 |
| D9920 |
|
14 |
14 |
$242.00 |
| D0601 |
|
15 |
15 |
$140.00 |
| D1330 |
|
38 |
38 |
$0.00 |
| D1999 |
|
60 |
60 |
$0.00 |