| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
3,829 |
3,510 |
$496.00 |
| D0220 |
Intraoral - periapical first radiographic image |
3,270 |
2,959 |
$153.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
805 |
388 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,104 |
1,946 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,848 |
2,656 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
209 |
95 |
$0.00 |
| D1330 |
|
6,714 |
6,054 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,814 |
2,669 |
$0.00 |
| D0602 |
|
292 |
292 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
1,121 |
1,021 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
92 |
92 |
$0.00 |
| D0603 |
|
1,091 |
1,021 |
$0.00 |
| D0601 |
|
483 |
447 |
$0.00 |
| D2160 |
|
17 |
13 |
$0.00 |
| D1310 |
|
111 |
110 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
49 |
48 |
$0.00 |
| D1351 |
Sealant - per tooth |
228 |
88 |
$0.00 |
| D1354 |
|
1,732 |
545 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
2,236 |
2,158 |
$0.00 |
| D1110 |
Prophylaxis - adult |
2,583 |
2,444 |
$0.00 |
| D1120 |
Prophylaxis - child |
406 |
403 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
399 |
278 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
63 |
$0.00 |
| D0191 |
|
225 |
214 |
$0.00 |
| D2140 |
|
63 |
45 |
$0.00 |
| D0330 |
Panoramic radiographic image |
24 |
12 |
$0.00 |