| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,262 |
5,249 |
$164K |
| D0120 |
Periodic oral evaluation - established patient |
4,572 |
4,565 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,705 |
1,055 |
$76K |
| D0330 |
Panoramic radiographic image |
3,097 |
3,093 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,290 |
3,284 |
$63K |
| D1120 |
Prophylaxis - child |
2,260 |
2,256 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
852 |
496 |
$33K |
| D0274 |
Bitewings - four radiographic images |
2,174 |
2,168 |
$30K |
| D0272 |
Bitewings - two radiographic images |
3,115 |
3,114 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,942 |
2,884 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,203 |
1,203 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
736 |
730 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
351 |
209 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,428 |
2,222 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,173 |
1,170 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
1,018 |
1,002 |
$8K |
| D9110 |
|
465 |
462 |
$7K |
| D1351 |
Sealant - per tooth |
104 |
26 |
$2K |
| D9310 |
|
26 |
26 |
$780.00 |
| D0270 |
|
25 |
24 |
$166.78 |
| D0601 |
|
92 |
92 |
$62.00 |