| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
2,101 |
2,059 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,842 |
1,812 |
$0.00 |
| D1110 |
Prophylaxis - adult |
2,419 |
2,381 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
2,667 |
2,629 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
818 |
548 |
$0.00 |
| D4910 |
|
77 |
77 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
15 |
$0.00 |
| D4341 |
|
68 |
26 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
4,381 |
4,264 |
$0.00 |
| D0601 |
|
2,952 |
2,865 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,173 |
891 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,242 |
1,225 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
227 |
93 |
$0.00 |
| D0602 |
|
906 |
862 |
$0.00 |
| D0603 |
|
1,831 |
1,739 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,289 |
3,226 |
$0.00 |
| D1310 |
|
5,626 |
5,477 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,292 |
1,256 |
$0.00 |
| D1330 |
|
5,678 |
5,514 |
$0.00 |
| D1320 |
|
580 |
570 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,761 |
1,707 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
959 |
933 |
$0.00 |
| D1351 |
Sealant - per tooth |
131 |
38 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
24 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |