| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
21,864 |
21,720 |
$703K |
| D1120 |
Prophylaxis - child |
16,582 |
16,441 |
$536K |
| D1110 |
Prophylaxis - adult |
7,067 |
7,044 |
$501K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,847 |
12,750 |
$280K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,981 |
3,289 |
$206K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,488 |
3,576 |
$187K |
| D1351 |
Sealant - per tooth |
5,758 |
2,260 |
$170K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,858 |
2,836 |
$128K |
| D1310 |
|
4,763 |
4,752 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,867 |
1,451 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
7,375 |
7,184 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,348 |
1,342 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,923 |
1,897 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,731 |
5,021 |
$42K |
| D0272 |
Bitewings - two radiographic images |
3,233 |
3,199 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,439 |
1,429 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
320 |
295 |
$22K |
| D0601 |
|
3,218 |
3,210 |
$18K |
| D0603 |
|
1,481 |
1,481 |
$9K |
| D0270 |
|
1,943 |
1,910 |
$8K |
| D2331 |
|
140 |
104 |
$8K |
| D0999 |
Unspecified diagnostic procedure, by report |
116 |
116 |
$7K |
| D1999 |
|
100 |
100 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
29 |
27 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$1K |
| D9987 |
|
180 |
177 |
$0.00 |
| D9993 |
|
3,809 |
3,799 |
$0.00 |
| D9986 |
|
1,404 |
1,374 |
$0.00 |