| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,285 |
9,161 |
$796K |
| D1120 |
Prophylaxis - child |
18,723 |
18,682 |
$724K |
| D0140 |
Limited oral evaluation - problem focused |
8,815 |
8,461 |
$701K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,529 |
3,519 |
$551K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,023 |
9,969 |
$539K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,365 |
3,383 |
$532K |
| D1206 |
Topical application of fluoride varnish |
21,159 |
21,108 |
$517K |
| D0120 |
Periodic oral evaluation - established patient |
10,209 |
10,131 |
$400K |
| D1351 |
Sealant - per tooth |
12,993 |
3,425 |
$361K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,319 |
2,514 |
$328K |
| D0274 |
Bitewings - four radiographic images |
7,766 |
7,693 |
$181K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,199 |
1,108 |
$164K |
| D0210 |
Intraoral - complete series of radiographic images |
4,378 |
4,328 |
$148K |
| D4355 |
|
866 |
840 |
$102K |
| D0272 |
Bitewings - two radiographic images |
2,431 |
2,427 |
$53K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,632 |
1,631 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
393 |
274 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,691 |
4,581 |
$36K |
| D2331 |
|
312 |
221 |
$28K |
| D2330 |
|
202 |
145 |
$16K |
| D2335 |
|
72 |
54 |
$9K |
| D2940 |
|
87 |
75 |
$9K |
| D0191 |
|
321 |
321 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
410 |
348 |
$2K |
| D2332 |
|
21 |
12 |
$2K |
| D0180 |
|
820 |
791 |
$2K |
| D1352 |
|
21 |
14 |
$1K |
| D0270 |
|
203 |
201 |
$795.52 |
| D4346 |
|
12 |
12 |
$771.26 |
| D9310 |
|
12 |
12 |
$225.24 |
| D1330 |
|
192 |
178 |
$104.00 |
| D9995 |
|
298 |
296 |
$0.00 |