| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,668 |
4,650 |
$269K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,085 |
2,231 |
$267K |
| D1110 |
Prophylaxis - adult |
2,810 |
2,803 |
$236K |
| D9430 |
|
4,694 |
4,107 |
$147K |
| D1120 |
Prophylaxis - child |
3,503 |
3,485 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,205 |
1,237 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,776 |
1,773 |
$106K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,251 |
872 |
$98K |
| D0210 |
Intraoral - complete series of radiographic images |
1,373 |
1,369 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,026 |
616 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,216 |
4,195 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,487 |
4,072 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,842 |
1,828 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,078 |
2,924 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,890 |
1,884 |
$32K |
| D2330 |
|
424 |
244 |
$31K |
| D1351 |
Sealant - per tooth |
1,027 |
331 |
$21K |
| D2332 |
|
120 |
76 |
$10K |
| D2335 |
|
48 |
26 |
$6K |
| D2394 |
|
52 |
41 |
$4K |
| D4341 |
|
42 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
135 |
134 |
$2K |
| D1320 |
|
92 |
92 |
$1K |
| D9110 |
|
25 |
25 |
$441.00 |
| D1310 |
|
60 |
60 |
$0.00 |