| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
23,161 |
13,393 |
$723K |
| D1110 |
Prophylaxis - adult |
12,554 |
9,033 |
$506K |
| D9999 |
Unspecified adjunctive procedure, by report |
3,154 |
2,898 |
$435K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,722 |
1,326 |
$125K |
| D0274 |
Bitewings - four radiographic images |
4,717 |
4,260 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,353 |
2,093 |
$105K |
| D1120 |
Prophylaxis - child |
2,389 |
1,475 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
951 |
645 |
$67K |
| D1351 |
Sealant - per tooth |
1,355 |
287 |
$48K |
| D0330 |
Panoramic radiographic image |
1,475 |
1,289 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,647 |
1,273 |
$39K |
| D4910 |
|
514 |
225 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
365 |
249 |
$29K |
| D1999 |
|
1,563 |
1,015 |
$27K |
| D2331 |
|
250 |
181 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
184 |
139 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,270 |
1,160 |
$17K |
| D4341 |
|
158 |
82 |
$13K |
| D1206 |
Topical application of fluoride varnish |
453 |
274 |
$12K |
| D2330 |
|
149 |
83 |
$12K |
| D0602 |
|
535 |
370 |
$9K |
| D0272 |
Bitewings - two radiographic images |
378 |
262 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
461 |
454 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
211 |
$5K |
| D0603 |
|
564 |
464 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
13 |
$2K |
| D2332 |
|
20 |
12 |
$2K |
| D0190 |
|
97 |
43 |
$2K |
| D9995 |
|
18 |
17 |
$295.53 |
| D9991 |
|
14 |
14 |
$27.00 |
| D0601 |
|
99 |
99 |
$0.00 |