| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,932 |
2,806 |
$119K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,567 |
757 |
$90K |
| D1206 |
Topical application of fluoride varnish |
3,917 |
3,744 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,144 |
571 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,130 |
1,059 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,103 |
1,962 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,247 |
2,162 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,683 |
1,582 |
$39K |
| D0330 |
Panoramic radiographic image |
917 |
849 |
$31K |
| D1120 |
Prophylaxis - child |
868 |
832 |
$28K |
| D5110 |
|
28 |
28 |
$18K |
| D4355 |
|
222 |
203 |
$18K |
| D5120 |
|
24 |
24 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
241 |
41 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
927 |
822 |
$8K |
| D4342 |
|
114 |
32 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
141 |
134 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
365 |
272 |
$2K |
| D0272 |
Bitewings - two radiographic images |
87 |
82 |
$1K |
| D2330 |
|
40 |
13 |
$1K |
| D1999 |
|
48 |
41 |
$0.00 |