| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,296 |
6,253 |
$261K |
| D1110 |
Prophylaxis - adult |
3,319 |
3,294 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,027 |
1,027 |
$105K |
| D1120 |
Prophylaxis - child |
4,017 |
3,984 |
$45K |
| D1351 |
Sealant - per tooth |
3,553 |
973 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
812 |
800 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,193 |
637 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,881 |
1,860 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,050 |
4,925 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
83 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,193 |
7,138 |
$9K |
| D0330 |
Panoramic radiographic image |
268 |
266 |
$8K |
| D0274 |
Bitewings - four radiographic images |
2,976 |
2,957 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
284 |
280 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
98 |
98 |
$5K |
| D1330 |
|
7,187 |
7,131 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
176 |
172 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
5,144 |
5,089 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
37 |
$1K |
| D9920 |
|
24 |
24 |
$849.00 |
| D0602 |
|
2,050 |
2,024 |
$390.00 |
| D3120 |
|
203 |
117 |
$372.35 |
| D0601 |
|
2,886 |
2,870 |
$80.00 |
| D1206 |
Topical application of fluoride varnish |
79 |
79 |
$0.00 |