| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,982 |
3,952 |
$339K |
| D0120 |
Periodic oral evaluation - established patient |
5,466 |
5,431 |
$323K |
| D0230 |
Intraoral - periapical each additional radiographic image |
54,748 |
9,886 |
$210K |
| D1120 |
Prophylaxis - child |
3,659 |
3,641 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,896 |
1,163 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,005 |
1,998 |
$126K |
| D0274 |
Bitewings - four radiographic images |
5,977 |
5,949 |
$125K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,351 |
698 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,755 |
2,741 |
$29K |
| D9430 |
|
701 |
699 |
$22K |
| D0350 |
|
2,260 |
953 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,760 |
1,724 |
$21K |
| D0272 |
Bitewings - two radiographic images |
941 |
931 |
$10K |
| D1351 |
Sealant - per tooth |
346 |
107 |
$7K |
| D2330 |
|
83 |
43 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
81 |
52 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
27 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
46 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D1999 |
|
38 |
36 |
$0.00 |