| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,499 |
5,212 |
$901K |
| D0140 |
Limited oral evaluation - problem focused |
2,905 |
2,653 |
$477K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,336 |
1,167 |
$255K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,522 |
1,152 |
$204K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,397 |
981 |
$170K |
| D1110 |
Prophylaxis - adult |
4,715 |
4,412 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
177 |
103 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
122 |
117 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
41 |
$11K |
| D4341 |
|
32 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
2,152 |
2,023 |
$2K |
| D1206 |
Topical application of fluoride varnish |
7,157 |
6,739 |
$1K |
| D0274 |
Bitewings - four radiographic images |
3,923 |
3,648 |
$1K |
| D0330 |
Panoramic radiographic image |
2,155 |
1,973 |
$547.17 |
| D0220 |
Intraoral - periapical first radiographic image |
6,418 |
5,825 |
$521.82 |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,469 |
4,540 |
$498.90 |
| D1330 |
|
2,026 |
1,885 |
$30.27 |
| D0270 |
|
255 |
213 |
$0.00 |
| D1351 |
Sealant - per tooth |
3,384 |
653 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
99 |
91 |
$0.00 |
| D1310 |
|
75 |
71 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$0.00 |