| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,214 |
4,203 |
$336K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
989 |
469 |
$44K |
| D1120 |
Prophylaxis - child |
451 |
450 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
662 |
649 |
$18K |
| D0330 |
Panoramic radiographic image |
350 |
350 |
$15K |
| D0274 |
Bitewings - four radiographic images |
3,805 |
3,795 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
94 |
94 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
5,416 |
5,400 |
$4K |
| D9420 |
|
39 |
39 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
30 |
$968.63 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
98 |
$490.48 |
| D0220 |
Intraoral - periapical first radiographic image |
5,229 |
4,915 |
$480.04 |
| D1351 |
Sealant - per tooth |
1,025 |
241 |
$441.03 |
| D4910 |
|
12 |
12 |
$429.07 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
14 |
$235.76 |
| D0272 |
Bitewings - two radiographic images |
471 |
470 |
$41.47 |
| D1206 |
Topical application of fluoride varnish |
1,552 |
1,551 |
$28.50 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,541 |
2,533 |
$-129.39 |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,416 |
2,476 |
$-378.98 |