| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,864 |
7,854 |
$278K |
| D0120 |
Periodic oral evaluation - established patient |
8,164 |
8,154 |
$171K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,836 |
9,762 |
$152K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,703 |
1,436 |
$113K |
| D0272 |
Bitewings - two radiographic images |
8,804 |
8,798 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,212 |
1,734 |
$98K |
| D1120 |
Prophylaxis - child |
2,246 |
2,246 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
10,468 |
10,436 |
$85K |
| D1351 |
Sealant - per tooth |
979 |
791 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,816 |
2,816 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,225 |
4,224 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
3,094 |
3,083 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
343 |
327 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
29 |
25 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
737 |
724 |
$6K |
| D2330 |
|
105 |
98 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
51 |
49 |
$3K |
| D2954 |
|
30 |
25 |
$3K |
| D2335 |
|
29 |
29 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
32 |
$2K |
| D1999 |
|
2,380 |
2,337 |
$0.00 |