| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,287 |
7,196 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
6,330 |
6,240 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,847 |
4,804 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,682 |
8,905 |
$29K |
| D2750 |
|
207 |
171 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
2,430 |
2,409 |
$17K |
| D4341 |
|
1,290 |
673 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
10,526 |
10,124 |
$15K |
| D1120 |
Prophylaxis - child |
2,783 |
2,761 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,550 |
1,006 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
2,595 |
2,540 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,616 |
3,575 |
$11K |
| D0272 |
Bitewings - two radiographic images |
5,038 |
4,966 |
$9K |
| D1206 |
Topical application of fluoride varnish |
2,095 |
2,071 |
$9K |
| D1351 |
Sealant - per tooth |
2,878 |
624 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
648 |
498 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
290 |
237 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
24 |
$2K |
| D2954 |
|
78 |
68 |
$1K |
| D0274 |
Bitewings - four radiographic images |
314 |
313 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
119 |
92 |
$574.25 |
| D0602 |
|
209 |
207 |
$560.00 |
| D0601 |
|
248 |
247 |
$350.00 |
| D9110 |
|
81 |
81 |
$334.00 |
| D2950 |
|
14 |
14 |
$225.00 |
| D0170 |
|
26 |
25 |
$48.00 |
| D9211 |
|
259 |
221 |
$0.00 |
| D9310 |
|
14 |
14 |
$0.00 |