| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
11,208 |
11,045 |
$743K |
| D0120 |
Periodic oral evaluation - established patient |
15,675 |
15,456 |
$491K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,504 |
1,923 |
$455K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,015 |
18,766 |
$446K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,305 |
6,210 |
$424K |
| D1120 |
Prophylaxis - child |
8,757 |
8,644 |
$386K |
| D0274 |
Bitewings - four radiographic images |
8,471 |
8,345 |
$321K |
| D0220 |
Intraoral - periapical first radiographic image |
15,746 |
15,386 |
$263K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,611 |
12,288 |
$191K |
| D0140 |
Limited oral evaluation - problem focused |
3,905 |
3,778 |
$171K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,466 |
826 |
$146K |
| D1351 |
Sealant - per tooth |
2,458 |
547 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
811 |
802 |
$54K |
| D4341 |
|
378 |
114 |
$50K |
| D0272 |
Bitewings - two radiographic images |
1,380 |
1,368 |
$49K |
| D0350 |
|
334 |
331 |
$26K |
| D2750 |
|
50 |
39 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
152 |
110 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
237 |
143 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
124 |
78 |
$19K |
| D9999 |
Unspecified adjunctive procedure, by report |
31 |
26 |
$0.00 |
| D1999 |
|
84 |
75 |
$0.00 |