| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,934 |
7,891 |
$166K |
| D0274 |
Bitewings - four radiographic images |
5,243 |
5,222 |
$140K |
| D1110 |
Prophylaxis - adult |
3,420 |
3,402 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,818 |
1,507 |
$107K |
| D1120 |
Prophylaxis - child |
2,821 |
2,809 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,470 |
1,828 |
$98K |
| D0330 |
Panoramic radiographic image |
2,051 |
2,041 |
$86K |
| D1351 |
Sealant - per tooth |
3,311 |
1,140 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,402 |
1,396 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,771 |
1,747 |
$27K |
| D9430 |
|
3,496 |
3,245 |
$26K |
| D1206 |
Topical application of fluoride varnish |
5,751 |
5,723 |
$21K |
| D9999 |
Unspecified adjunctive procedure, by report |
233 |
231 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
211 |
160 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,140 |
7,380 |
$7K |
| D0272 |
Bitewings - two radiographic images |
3,635 |
3,619 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
8,735 |
8,644 |
$6K |
| D1330 |
|
6,426 |
6,395 |
$6K |
| D1999 |
|
38 |
38 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
30 |
$957.50 |
| D1208 |
Topical application of fluoride, excluding varnish |
313 |
313 |
$738.19 |
| D0601 |
|
4,413 |
4,389 |
$441.00 |
| D0603 |
|
3,167 |
3,152 |
$293.00 |
| D0270 |
|
156 |
154 |
$111.13 |
| D0602 |
|
16 |
16 |
$0.00 |