| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,072 |
3,807 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,972 |
1,913 |
$95K |
| D1120 |
Prophylaxis - child |
2,528 |
2,383 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,586 |
4,598 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
1,330 |
1,300 |
$41K |
| D0274 |
Bitewings - four radiographic images |
3,574 |
3,453 |
$38K |
| D1110 |
Prophylaxis - adult |
689 |
664 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,416 |
2,303 |
$31K |
| D0350 |
|
1,254 |
311 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
118 |
53 |
$7K |
| D1351 |
Sealant - per tooth |
449 |
88 |
$7K |
| D9430 |
|
225 |
214 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
43 |
42 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
88 |
45 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
482 |
435 |
$2K |
| D4910 |
|
38 |
38 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
24 |
$2K |
| D4341 |
|
28 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
173 |
170 |
$2K |
| D1206 |
Topical application of fluoride varnish |
45 |
45 |
$500.00 |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$333.00 |
| D1330 |
|
232 |
196 |
$0.00 |