| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,366 |
5,091 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,754 |
2,731 |
$160K |
| D1120 |
Prophylaxis - child |
3,984 |
3,779 |
$107K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,303 |
7,038 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,873 |
1,861 |
$78K |
| D0274 |
Bitewings - four radiographic images |
5,389 |
5,098 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,218 |
4,022 |
$43K |
| D1351 |
Sealant - per tooth |
1,855 |
405 |
$41K |
| D9430 |
|
1,076 |
1,024 |
$31K |
| D1110 |
Prophylaxis - adult |
438 |
434 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
338 |
153 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
442 |
224 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
274 |
140 |
$14K |
| D4341 |
|
90 |
29 |
$5K |
| D0272 |
Bitewings - two radiographic images |
414 |
412 |
$4K |
| D0330 |
Panoramic radiographic image |
345 |
343 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
12 |
$2K |
| D0350 |
|
262 |
77 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
247 |
221 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
63 |
62 |
$939.71 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$804.00 |
| D1320 |
|
49 |
49 |
$778.13 |
| D0270 |
|
39 |
38 |
$135.00 |
| D1203 |
|
15 |
15 |
$0.00 |
| D1330 |
|
430 |
332 |
$0.00 |