| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,938 |
2,907 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,726 |
929 |
$101K |
| D0274 |
Bitewings - four radiographic images |
2,046 |
2,018 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
1,241 |
1,224 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,165 |
2,138 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,054 |
649 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,961 |
1,935 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
585 |
384 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
488 |
237 |
$31K |
| D2331 |
|
248 |
160 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
416 |
406 |
$15K |
| D1120 |
Prophylaxis - child |
444 |
439 |
$13K |
| D1351 |
Sealant - per tooth |
499 |
63 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
618 |
614 |
$11K |
| D0330 |
Panoramic radiographic image |
290 |
288 |
$11K |
| D2332 |
|
156 |
106 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
755 |
735 |
$6K |
| D0272 |
Bitewings - two radiographic images |
313 |
309 |
$5K |
| D2330 |
|
69 |
41 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
206 |
190 |
$2K |
| D0270 |
|
186 |
183 |
$1K |
| D0601 |
|
128 |
128 |
$1K |
| D1330 |
|
204 |
204 |
$961.92 |
| D1206 |
Topical application of fluoride varnish |
55 |
55 |
$915.66 |
| D1310 |
|
12 |
12 |
$134.40 |