| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,287 |
11,032 |
$2.77M |
| D0140 |
Limited oral evaluation - problem focused |
4,208 |
3,968 |
$984K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,270 |
3,218 |
$719K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,615 |
2,566 |
$552K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,288 |
2,395 |
$475K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,851 |
1,300 |
$214K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
404 |
369 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
386 |
319 |
$37K |
| D0145 |
Oral evaluation for a patient under three years of age |
140 |
139 |
$18K |
| D1352 |
|
500 |
231 |
$15K |
| D2331 |
|
60 |
53 |
$11K |
| D2160 |
|
101 |
88 |
$6K |
| D1110 |
Prophylaxis - adult |
6,180 |
6,028 |
$4K |
| D2140 |
|
15 |
13 |
$2K |
| D2330 |
|
19 |
14 |
$2K |
| D0274 |
Bitewings - four radiographic images |
6,669 |
6,517 |
$2K |
| D1120 |
Prophylaxis - child |
8,139 |
7,944 |
$2K |
| D1206 |
Topical application of fluoride varnish |
10,342 |
10,108 |
$2K |
| D1351 |
Sealant - per tooth |
2,561 |
1,003 |
$2K |
| D0330 |
Panoramic radiographic image |
3,270 |
3,196 |
$1K |
| D0272 |
Bitewings - two radiographic images |
3,089 |
3,015 |
$570.24 |
| D0220 |
Intraoral - periapical first radiographic image |
4,751 |
4,495 |
$522.78 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,327 |
617 |
$244.23 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
541 |
473 |
$86.73 |
| D0270 |
|
71 |
66 |
$0.00 |