| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,825 |
4,796 |
$231K |
| D1120 |
Prophylaxis - child |
4,647 |
4,621 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,385 |
6,711 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,292 |
686 |
$85K |
| D0274 |
Bitewings - four radiographic images |
3,384 |
3,379 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,407 |
5,380 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
861 |
858 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
884 |
423 |
$47K |
| D0350 |
|
4,081 |
1,688 |
$41K |
| D1110 |
Prophylaxis - adult |
442 |
442 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
607 |
607 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
267 |
152 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,574 |
1,559 |
$17K |
| D1351 |
Sealant - per tooth |
663 |
212 |
$17K |
| D9993 |
|
260 |
260 |
$16K |
| D1310 |
|
365 |
363 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
149 |
67 |
$10K |
| D9430 |
|
203 |
202 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
57 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
250 |
248 |
$3K |
| D4341 |
|
40 |
12 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
12 |
$2K |
| D0603 |
|
132 |
131 |
$2K |
| D0601 |
|
13 |
13 |
$195.00 |
| D1999 |
|
44 |
44 |
$138.00 |