| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,535 |
6,332 |
$161K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,729 |
2,394 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,274 |
4,161 |
$107K |
| D2750 |
|
388 |
320 |
$102K |
| D1110 |
Prophylaxis - adult |
4,955 |
4,751 |
$98K |
| D0210 |
Intraoral - complete series of radiographic images |
3,465 |
3,354 |
$94K |
| D1120 |
Prophylaxis - child |
4,237 |
4,092 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
3,584 |
3,308 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,142 |
741 |
$40K |
| D0274 |
Bitewings - four radiographic images |
4,414 |
4,279 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,874 |
3,745 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
603 |
432 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
7,373 |
7,042 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
752 |
449 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
447 |
284 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,695 |
5,123 |
$16K |
| D2954 |
|
242 |
207 |
$11K |
| D4341 |
|
288 |
114 |
$11K |
| D0330 |
Panoramic radiographic image |
483 |
474 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
14 |
$5K |
| D2740 |
Crown - porcelain/ceramic |
15 |
12 |
$4K |
| D2335 |
|
32 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
271 |
267 |
$1K |
| D1351 |
Sealant - per tooth |
67 |
17 |
$704.00 |
| D4910 |
|
13 |
12 |
$252.00 |
| D0270 |
|
48 |
47 |
$136.50 |
| D1999 |
|
2,305 |
2,058 |
$0.00 |
| D1330 |
|
459 |
456 |
$0.00 |