| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
7,074 |
6,767 |
$1.20M |
| D0120 |
Periodic oral evaluation - established patient |
2,469 |
2,437 |
$428K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,330 |
2,307 |
$374K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,803 |
1,406 |
$213K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,513 |
1,050 |
$141K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,389 |
1,038 |
$117K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
287 |
247 |
$37K |
| D2335 |
|
26 |
24 |
$2K |
| D1999 |
|
149 |
129 |
$429.68 |
| D0274 |
Bitewings - four radiographic images |
3,891 |
3,857 |
$410.48 |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,650 |
2,814 |
$312.78 |
| D0220 |
Intraoral - periapical first radiographic image |
6,969 |
6,779 |
$284.73 |
| D1110 |
Prophylaxis - adult |
3,522 |
3,492 |
$250.98 |
| D0330 |
Panoramic radiographic image |
1,259 |
1,248 |
$154.73 |
| D4355 |
|
727 |
720 |
$71.41 |
| D1206 |
Topical application of fluoride varnish |
2,386 |
2,362 |
$14.70 |
| D0270 |
|
1,144 |
1,130 |
$6.40 |
| D1120 |
Prophylaxis - child |
1,294 |
1,283 |
$0.00 |
| D1351 |
Sealant - per tooth |
381 |
106 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
281 |
278 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
182 |
180 |
$0.00 |