| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,362 |
3,164 |
$164K |
| D0274 |
Bitewings - four radiographic images |
2,382 |
2,257 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
3,564 |
3,340 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
4,588 |
4,095 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,561 |
1,429 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,721 |
3,015 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
442 |
188 |
$32K |
| D1120 |
Prophylaxis - child |
619 |
588 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
346 |
187 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
894 |
848 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
123 |
51 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
360 |
339 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
98 |
91 |
$6K |
| D8670 |
Periodic orthodontic treatment visit |
25 |
24 |
$6K |
| D2950 |
|
15 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
78 |
77 |
$2K |
| D0272 |
Bitewings - two radiographic images |
67 |
61 |
$2K |
| D1351 |
Sealant - per tooth |
39 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
13 |
$1K |
| D0270 |
|
62 |
39 |
$367.00 |