| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
12,711 |
12,707 |
$541K |
| D0274 |
Bitewings - four radiographic images |
12,492 |
12,489 |
$253K |
| D0120 |
Periodic oral evaluation - established patient |
11,288 |
11,283 |
$240K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,091 |
2,238 |
$203K |
| D0220 |
Intraoral - periapical first radiographic image |
15,350 |
15,280 |
$147K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,700 |
1,885 |
$121K |
| D4341 |
|
2,221 |
1,124 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,934 |
1,555 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,808 |
3,803 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,120 |
14,094 |
$80K |
| D1120 |
Prophylaxis - child |
1,934 |
1,922 |
$61K |
| D2750 |
|
141 |
116 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
2,429 |
2,399 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,165 |
1,159 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
1,378 |
1,365 |
$14K |
| D0330 |
Panoramic radiographic image |
443 |
442 |
$13K |
| D0272 |
Bitewings - two radiographic images |
949 |
949 |
$12K |
| D1351 |
Sealant - per tooth |
190 |
113 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
974 |
973 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
90 |
69 |
$6K |
| D2331 |
|
82 |
73 |
$5K |
| D9310 |
|
134 |
134 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
53 |
$4K |
| D3320 |
|
14 |
13 |
$4K |
| D2954 |
|
29 |
26 |
$3K |
| D7230 |
|
20 |
14 |
$3K |
| D1354 |
|
18 |
12 |
$1K |
| D0240 |
|
41 |
41 |
$977.50 |
| D1999 |
|
100 |
99 |
$0.00 |