| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,978 |
4,957 |
$1.39M |
| D0140 |
Limited oral evaluation - problem focused |
3,300 |
3,204 |
$457K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,529 |
1,285 |
$292K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,525 |
1,134 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
763 |
762 |
$107K |
| D5899 |
|
585 |
465 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
924 |
548 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
357 |
339 |
$58K |
| D2330 |
|
397 |
269 |
$16K |
| D2331 |
|
284 |
237 |
$15K |
| D2332 |
|
39 |
37 |
$7K |
| D2394 |
|
40 |
40 |
$5K |
| D1110 |
Prophylaxis - adult |
4,245 |
4,229 |
$30.52 |
| D0220 |
Intraoral - periapical first radiographic image |
2,956 |
2,845 |
$14.02 |
| D0274 |
Bitewings - four radiographic images |
3,166 |
3,151 |
$3.60 |
| D1206 |
Topical application of fluoride varnish |
1,342 |
1,335 |
$0.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
393 |
218 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
177 |
177 |
$0.00 |
| D4355 |
|
12 |
12 |
$0.00 |
| D0330 |
Panoramic radiographic image |
623 |
619 |
$0.00 |
| D1120 |
Prophylaxis - child |
946 |
942 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
17 |
$0.00 |