| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,944 |
7,908 |
$447K |
| D1120 |
Prophylaxis - child |
7,627 |
7,584 |
$294K |
| D1110 |
Prophylaxis - adult |
2,002 |
1,999 |
$168K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,308 |
1,321 |
$150K |
| D1351 |
Sealant - per tooth |
4,447 |
1,062 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,720 |
1,717 |
$108K |
| D0274 |
Bitewings - four radiographic images |
4,796 |
4,785 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,939 |
9,054 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,674 |
7,649 |
$89K |
| D0272 |
Bitewings - two radiographic images |
3,351 |
3,335 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
637 |
635 |
$30K |
| D9430 |
|
921 |
914 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
278 |
203 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
377 |
223 |
$20K |
| D0350 |
|
1,519 |
993 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
617 |
598 |
$7K |
| D4910 |
|
49 |
49 |
$4K |
| D0270 |
|
443 |
422 |
$2K |
| D2330 |
|
19 |
13 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
14 |
$918.40 |
| D1310 |
|
17 |
17 |
$782.00 |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$750.00 |