| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
11,799 |
7,105 |
$5.37M |
| D0220 |
Intraoral - periapical first radiographic image |
4,540 |
4,119 |
$662K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,811 |
1,771 |
$606K |
| D0120 |
Periodic oral evaluation - established patient |
1,093 |
995 |
$383K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,309 |
780 |
$362K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
835 |
576 |
$166K |
| D1110 |
Prophylaxis - adult |
1,729 |
1,618 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
296 |
213 |
$114K |
| D2740 |
Crown - porcelain/ceramic |
275 |
199 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,945 |
2,796 |
$97K |
| D2950 |
|
539 |
402 |
$90K |
| D1120 |
Prophylaxis - child |
239 |
234 |
$76K |
| D0330 |
Panoramic radiographic image |
1,014 |
972 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,656 |
2,540 |
$75K |
| D2140 |
|
244 |
141 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
305 |
102 |
$53K |
| D4355 |
|
139 |
128 |
$25K |
| D1351 |
Sealant - per tooth |
317 |
55 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
104 |
$14K |
| D2160 |
|
28 |
24 |
$10K |
| D2331 |
|
83 |
64 |
$6K |
| D1206 |
Topical application of fluoride varnish |
829 |
824 |
$5K |
| D2330 |
|
58 |
40 |
$4K |
| D3120 |
|
19 |
13 |
$3K |
| D2332 |
|
15 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
41 |
38 |
$2K |
| D1330 |
|
181 |
181 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
20 |
20 |
$0.00 |
| D4341 |
|
23 |
13 |
$0.00 |
| D4910 |
|
54 |
54 |
$0.00 |