| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,906 |
7,854 |
$477K |
| D1110 |
Prophylaxis - adult |
5,985 |
5,954 |
$473K |
| D0210 |
Intraoral - complete series of radiographic images |
6,728 |
6,704 |
$309K |
| D0120 |
Periodic oral evaluation - established patient |
5,438 |
5,361 |
$238K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,508 |
1,234 |
$140K |
| D9430 |
|
3,871 |
3,728 |
$118K |
| D0274 |
Bitewings - four radiographic images |
2,839 |
2,822 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
685 |
558 |
$46K |
| D2330 |
|
534 |
343 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,713 |
2,701 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
757 |
521 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,164 |
3,094 |
$36K |
| D0330 |
Panoramic radiographic image |
758 |
757 |
$22K |
| D9110 |
|
416 |
381 |
$18K |
| D2940 |
|
412 |
341 |
$17K |
| D4910 |
|
246 |
246 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,159 |
3,072 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
173 |
163 |
$14K |
| D1120 |
Prophylaxis - child |
295 |
294 |
$9K |
| D0270 |
|
1,421 |
1,382 |
$7K |
| D4341 |
|
124 |
49 |
$6K |
| D4342 |
|
71 |
32 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
51 |
$0.00 |
| D1310 |
|
30 |
29 |
$0.00 |