| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,467 |
10,465 |
$542K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,418 |
2,403 |
$288K |
| D0120 |
Periodic oral evaluation - established patient |
8,198 |
8,196 |
$221K |
| D0274 |
Bitewings - four radiographic images |
6,068 |
6,065 |
$161K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,539 |
1,154 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,053 |
1,450 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,758 |
3,756 |
$113K |
| D0330 |
Panoramic radiographic image |
2,448 |
2,448 |
$87K |
| D1120 |
Prophylaxis - child |
1,104 |
1,104 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,158 |
3,117 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,054 |
2,054 |
$29K |
| D2394 |
|
158 |
125 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
301 |
185 |
$18K |
| D9110 |
|
372 |
372 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
582 |
581 |
$8K |
| D2335 |
|
71 |
29 |
$8K |
| D2332 |
|
31 |
26 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
26 |
$3K |
| D2331 |
|
30 |
27 |
$3K |
| D4910 |
|
46 |
46 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
101 |
100 |
$2K |
| D0272 |
Bitewings - two radiographic images |
80 |
80 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
51 |
$379.34 |