| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
930 |
757 |
$5K |
| D1110 |
Prophylaxis - adult |
512 |
420 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
846 |
745 |
$2K |
| D1120 |
Prophylaxis - child |
532 |
459 |
$2K |
| D1206 |
Topical application of fluoride varnish |
1,063 |
901 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
261 |
203 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
730 |
672 |
$574.12 |
| D0120 |
Periodic oral evaluation - established patient |
483 |
464 |
$28.00 |
| D1351 |
Sealant - per tooth |
47 |
12 |
$0.00 |
| D1330 |
|
715 |
670 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
119 |
64 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
76 |
51 |
$0.00 |
| D0601 |
|
67 |
67 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
317 |
156 |
$0.00 |
| D0603 |
|
281 |
263 |
$0.00 |
| D0602 |
|
41 |
41 |
$0.00 |
| D1310 |
|
129 |
128 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
274 |
265 |
$0.00 |
| D0330 |
Panoramic radiographic image |
195 |
187 |
$0.00 |
| D0191 |
|
162 |
162 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
15 |
$0.00 |