| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,583 |
8,305 |
$234K |
| D1120 |
Prophylaxis - child |
5,773 |
5,603 |
$231K |
| D4341 |
|
796 |
470 |
$166K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,671 |
1,289 |
$114K |
| D9110 |
|
2,111 |
2,051 |
$107K |
| D1110 |
Prophylaxis - adult |
2,380 |
2,304 |
$94K |
| D1206 |
Topical application of fluoride varnish |
3,422 |
3,274 |
$86K |
| D0274 |
Bitewings - four radiographic images |
4,534 |
4,383 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
3,585 |
3,421 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,234 |
2,144 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
5,908 |
5,442 |
$35K |
| D0330 |
Panoramic radiographic image |
1,027 |
970 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
319 |
279 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
204 |
170 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
322 |
272 |
$14K |
| D2950 |
|
223 |
213 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,449 |
2,250 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,337 |
1,297 |
$13K |
| D1351 |
Sealant - per tooth |
128 |
77 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
101 |
83 |
$9K |
| D2752 |
|
26 |
25 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
171 |
170 |
$3K |
| D8999 |
|
73 |
68 |
$3K |
| D2332 |
|
18 |
12 |
$1K |
| D9310 |
|
19 |
19 |
$324.90 |
| D1999 |
|
42 |
40 |
$0.00 |
| D0340 |
|
26 |
25 |
$0.00 |