| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,682 |
4,656 |
$185K |
| D0120 |
Periodic oral evaluation - established patient |
4,206 |
4,180 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,523 |
1,522 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
1,798 |
1,745 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,309 |
887 |
$62K |
| D1120 |
Prophylaxis - child |
1,172 |
1,168 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,387 |
2,376 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,533 |
1,531 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
410 |
176 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,523 |
4,425 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
5,845 |
5,648 |
$25K |
| D0274 |
Bitewings - four radiographic images |
2,916 |
2,892 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
190 |
148 |
$9K |
| D0330 |
Panoramic radiographic image |
1,447 |
1,432 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
42 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
37 |
$2K |
| D0270 |
|
448 |
448 |
$2K |
| D1351 |
Sealant - per tooth |
68 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
199 |
198 |
$1K |
| D2332 |
|
30 |
24 |
$1K |
| D4999 |
|
18 |
18 |
$0.00 |
| D1999 |
|
2,728 |
2,439 |
$0.00 |