| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,102 |
2,036 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
1,112 |
1,096 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
534 |
277 |
$17K |
| D0330 |
Panoramic radiographic image |
588 |
576 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
828 |
809 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,433 |
2,355 |
$11K |
| D1120 |
Prophylaxis - child |
473 |
465 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,300 |
2,696 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
134 |
82 |
$8K |
| D0272 |
Bitewings - two radiographic images |
2,281 |
2,199 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
333 |
170 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
1,163 |
1,094 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
507 |
183 |
$5K |
| D1351 |
Sealant - per tooth |
419 |
93 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
3,103 |
2,958 |
$3K |
| D2332 |
|
72 |
43 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
74 |
74 |
$2K |
| D1330 |
|
2,533 |
2,445 |
$1K |
| D0601 |
|
108 |
107 |
$495.00 |
| D0602 |
|
85 |
85 |
$360.00 |
| D0603 |
|
15 |
15 |
$75.00 |
| D9986 |
|
546 |
527 |
$0.00 |