| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 512 |
|
13,289 |
12,093 |
$2.93M |
| D0120 |
Periodic oral evaluation - established patient |
5,602 |
5,311 |
$926K |
| D0140 |
Limited oral evaluation - problem focused |
3,604 |
3,307 |
$642K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,179 |
2,063 |
$333K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,087 |
1,661 |
$268K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,926 |
1,407 |
$201K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,516 |
1,197 |
$186K |
| D1120 |
Prophylaxis - child |
3,313 |
3,092 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
135 |
121 |
$15K |
| D1110 |
Prophylaxis - adult |
3,627 |
3,496 |
$11K |
| D2331 |
|
73 |
51 |
$11K |
| D2332 |
|
61 |
48 |
$8K |
| D1351 |
Sealant - per tooth |
5,605 |
1,318 |
$3K |
| D2330 |
|
19 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
2,671 |
2,524 |
$428.00 |
| D0272 |
Bitewings - two radiographic images |
1,979 |
1,842 |
$287.00 |
| D0220 |
Intraoral - periapical first radiographic image |
3,990 |
3,751 |
$35.34 |
| D1206 |
Topical application of fluoride varnish |
6,472 |
6,015 |
$16.11 |
| D4355 |
|
28 |
28 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,075 |
620 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
518 |
426 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
3,650 |
3,508 |
$0.00 |
| D0270 |
|
532 |
476 |
$0.00 |
| D1999 |
|
223 |
179 |
$0.00 |