| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,543 |
3,534 |
$199K |
| D1110 |
Prophylaxis - adult |
2,047 |
2,044 |
$176K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,174 |
1,339 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,495 |
1,431 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,469 |
1,464 |
$88K |
| D1120 |
Prophylaxis - child |
2,251 |
2,244 |
$86K |
| D4910 |
|
871 |
864 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,122 |
3,141 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
1,298 |
1,291 |
$61K |
| D0350 |
|
3,585 |
2,597 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,939 |
3,929 |
$48K |
| D0330 |
Panoramic radiographic image |
1,254 |
1,252 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,288 |
1,285 |
$25K |
| D4341 |
|
345 |
93 |
$24K |
| D9430 |
|
652 |
646 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
166 |
110 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,436 |
1,431 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,322 |
1,301 |
$15K |
| D9110 |
|
138 |
128 |
$9K |
| D7240 |
Removal of impacted tooth - completely bony |
35 |
13 |
$8K |
| D2330 |
|
73 |
41 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
26 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
27 |
$2K |
| D1999 |
|
44 |
43 |
$10.00 |