| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,349 |
10,317 |
$613K |
| D1120 |
Prophylaxis - child |
13,672 |
13,641 |
$552K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,526 |
3,523 |
$234K |
| D1206 |
Topical application of fluoride varnish |
14,503 |
14,463 |
$217K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,033 |
9,426 |
$176K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,553 |
1,584 |
$168K |
| D0274 |
Bitewings - four radiographic images |
6,406 |
6,384 |
$136K |
| D1310 |
|
2,751 |
2,736 |
$124K |
| D1351 |
Sealant - per tooth |
4,161 |
1,164 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,933 |
1,140 |
$101K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,355 |
1,349 |
$89K |
| D9430 |
|
2,504 |
2,437 |
$79K |
| D1110 |
Prophylaxis - adult |
862 |
858 |
$76K |
| D4910 |
|
811 |
810 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
1,024 |
1,024 |
$49K |
| D0350 |
|
3,904 |
1,947 |
$38K |
| D0330 |
Panoramic radiographic image |
1,318 |
1,312 |
$38K |
| D0272 |
Bitewings - two radiographic images |
3,088 |
3,082 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
598 |
306 |
$34K |
| D0603 |
|
2,284 |
2,272 |
$33K |
| D2330 |
|
418 |
241 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
362 |
288 |
$29K |
| D1352 |
|
769 |
252 |
$19K |
| D4341 |
|
213 |
79 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
72 |
50 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
691 |
683 |
$8K |
| D0270 |
|
1,528 |
1,485 |
$8K |
| D1354 |
|
465 |
109 |
$5K |
| D0602 |
|
292 |
292 |
$4K |
| D2331 |
|
36 |
26 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
18 |
$1K |
| D2161 |
|
12 |
12 |
$1K |
| D9996 |
|
96 |
95 |
$0.00 |