| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,132 |
5,824 |
$200K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,562 |
1,310 |
$195K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,131 |
1,359 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
1,879 |
1,755 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
5,655 |
5,448 |
$93K |
| D0274 |
Bitewings - four radiographic images |
4,656 |
4,446 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,480 |
2,319 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
849 |
572 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,403 |
2,282 |
$35K |
| D0330 |
Panoramic radiographic image |
1,021 |
968 |
$33K |
| D1120 |
Prophylaxis - child |
1,600 |
1,515 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,051 |
1,013 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
271 |
198 |
$17K |
| D0272 |
Bitewings - two radiographic images |
643 |
624 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,282 |
1,207 |
$6K |
| D7230 |
|
23 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
134 |
29 |
$3K |
| D2931 |
|
20 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
205 |
143 |
$815.00 |
| D0270 |
|
12 |
12 |
$60.00 |
| D1999 |
|
51 |
49 |
$0.00 |