| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,836 |
13,679 |
$415K |
| D1120 |
Prophylaxis - child |
10,716 |
10,580 |
$390K |
| D1110 |
Prophylaxis - adult |
6,003 |
5,926 |
$302K |
| D1206 |
Topical application of fluoride varnish |
16,895 |
16,675 |
$282K |
| D1351 |
Sealant - per tooth |
13,525 |
2,504 |
$247K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,662 |
1,325 |
$173K |
| D0274 |
Bitewings - four radiographic images |
5,392 |
5,305 |
$156K |
| D0140 |
Limited oral evaluation - problem focused |
4,225 |
4,023 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,662 |
1,251 |
$131K |
| D0330 |
Panoramic radiographic image |
2,466 |
2,416 |
$130K |
| D1354 |
|
4,813 |
1,232 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,807 |
1,760 |
$97K |
| D1310 |
|
3,362 |
3,315 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
898 |
510 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
4,025 |
3,830 |
$52K |
| D0272 |
Bitewings - two radiographic images |
2,017 |
1,979 |
$37K |
| D2940 |
|
610 |
411 |
$25K |
| D0190 |
|
1,254 |
1,219 |
$22K |
| D3120 |
|
529 |
417 |
$11K |
| D0460 |
|
478 |
432 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
641 |
438 |
$6K |
| D1320 |
|
205 |
193 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
70 |
70 |
$2K |
| D9920 |
|
50 |
47 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D3221 |
|
17 |
12 |
$1K |
| D4910 |
|
13 |
13 |
$1K |
| D0191 |
|
72 |
66 |
$945.75 |
| D9992 |
|
30 |
30 |
$688.80 |
| D1330 |
|
53 |
52 |
$676.00 |
| D9996 |
|
759 |
756 |
$0.00 |
| D1999 |
|
53 |
43 |
$0.00 |
| D0603 |
|
14 |
14 |
$0.00 |