| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,662 |
5,619 |
$42K |
| D1110 |
Prophylaxis - adult |
5,217 |
5,178 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,674 |
1,071 |
$26K |
| D1120 |
Prophylaxis - child |
2,541 |
2,527 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,898 |
2,883 |
$18K |
| D0274 |
Bitewings - four radiographic images |
4,332 |
4,293 |
$17K |
| D0191 |
|
1,394 |
1,181 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
863 |
659 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
1,588 |
1,539 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
1,417 |
1,416 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
7,350 |
7,083 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,454 |
3,440 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,227 |
5,910 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
158 |
107 |
$3K |
| D4341 |
|
71 |
24 |
$2K |
| D0330 |
Panoramic radiographic image |
258 |
258 |
$1K |
| D0601 |
|
654 |
650 |
$710.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
40 |
$486.00 |
| D0603 |
|
152 |
151 |
$140.00 |
| D0602 |
|
133 |
133 |
$140.00 |
| D0160 |
|
95 |
82 |
$122.30 |
| D0272 |
Bitewings - two radiographic images |
34 |
33 |
$88.00 |
| D0270 |
|
28 |
27 |
$35.75 |
| D9310 |
|
175 |
157 |
$32.40 |
| D0180 |
|
12 |
12 |
$21.60 |
| D1330 |
|
346 |
330 |
$0.00 |
| D1999 |
|
925 |
761 |
$0.00 |
| D0190 |
|
141 |
119 |
$0.00 |