| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,220 |
3,037 |
$126K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,754 |
972 |
$105K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,708 |
840 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,276 |
4,045 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
3,176 |
3,001 |
$78K |
| D1120 |
Prophylaxis - child |
1,822 |
1,756 |
$73K |
| D8670 |
Periodic orthodontic treatment visit |
243 |
234 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,610 |
1,557 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
668 |
515 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,477 |
1,423 |
$37K |
| D1351 |
Sealant - per tooth |
677 |
264 |
$35K |
| D9110 |
|
515 |
495 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
383 |
256 |
$23K |
| D0272 |
Bitewings - two radiographic images |
2,440 |
2,336 |
$20K |
| D2940 |
|
1,353 |
960 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,184 |
1,075 |
$19K |
| D4341 |
|
97 |
58 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
285 |
208 |
$12K |
| D0274 |
Bitewings - four radiographic images |
726 |
688 |
$12K |
| D0330 |
Panoramic radiographic image |
741 |
697 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
61 |
55 |
$336.00 |
| D9995 |
|
21 |
16 |
$180.06 |
| D0230 |
Intraoral - periapical each additional radiographic image |
48 |
43 |
$178.60 |