| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
17,976 |
17,933 |
$697K |
| D0120 |
Periodic oral evaluation - established patient |
21,210 |
21,160 |
$456K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,952 |
4,494 |
$411K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,603 |
4,658 |
$360K |
| D0274 |
Bitewings - four radiographic images |
15,997 |
15,992 |
$332K |
| D0220 |
Intraoral - periapical first radiographic image |
23,934 |
23,784 |
$239K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,175 |
22,100 |
$203K |
| D4341 |
|
3,413 |
1,594 |
$160K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,081 |
1,424 |
$127K |
| D1120 |
Prophylaxis - child |
3,921 |
3,909 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,315 |
8,291 |
$96K |
| D2330 |
|
1,322 |
849 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
10,615 |
10,499 |
$59K |
| D2331 |
|
715 |
426 |
$50K |
| D2332 |
|
474 |
278 |
$37K |
| D2394 |
|
278 |
185 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,824 |
1,823 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
940 |
940 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
427 |
406 |
$18K |
| D1351 |
Sealant - per tooth |
160 |
146 |
$17K |
| D2335 |
|
146 |
117 |
$14K |
| D9110 |
|
724 |
723 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
785 |
785 |
$9K |