| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,127 |
7,962 |
$205K |
| D1110 |
Prophylaxis - adult |
4,954 |
4,837 |
$187K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,328 |
756 |
$135K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,007 |
614 |
$125K |
| D2394 |
|
725 |
378 |
$109K |
| D1120 |
Prophylaxis - child |
3,798 |
3,709 |
$103K |
| D1206 |
Topical application of fluoride varnish |
6,048 |
5,924 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
2,648 |
2,492 |
$92K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
204 |
183 |
$84K |
| D0274 |
Bitewings - four radiographic images |
1,994 |
1,928 |
$57K |
| D2931 |
|
292 |
248 |
$46K |
| D0330 |
Panoramic radiographic image |
1,348 |
1,291 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
932 |
874 |
$36K |
| D2950 |
|
360 |
303 |
$36K |
| D2335 |
|
272 |
127 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,155 |
2,044 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
237 |
104 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,290 |
1,260 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
285 |
191 |
$21K |
| D1351 |
Sealant - per tooth |
204 |
60 |
$6K |
| D3310 |
|
19 |
14 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
74 |
71 |
$4K |
| D4355 |
|
29 |
28 |
$2K |
| D2332 |
|
14 |
12 |
$1K |
| D2331 |
|
15 |
12 |
$1K |