| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,286 |
7,983 |
$317K |
| D0210 |
Intraoral - complete series of radiographic images |
2,214 |
2,079 |
$143K |
| D0274 |
Bitewings - four radiographic images |
5,587 |
5,409 |
$126K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,429 |
498 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,573 |
2,489 |
$46K |
| D1120 |
Prophylaxis - child |
1,724 |
1,666 |
$40K |
| D4341 |
|
381 |
133 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
276 |
177 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
937 |
906 |
$20K |
| D0330 |
Panoramic radiographic image |
409 |
396 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
24 |
12 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
433 |
408 |
$15K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
224 |
207 |
$9K |
| D0272 |
Bitewings - two radiographic images |
613 |
580 |
$8K |
| D1351 |
Sealant - per tooth |
384 |
100 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
43 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
470 |
445 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
279 |
236 |
$1K |
| D1999 |
|
19 |
19 |
$0.00 |