| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,053 |
6,041 |
$211K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,183 |
1,641 |
$128K |
| D0274 |
Bitewings - four radiographic images |
6,577 |
6,573 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
6,177 |
6,169 |
$124K |
| D1120 |
Prophylaxis - child |
2,170 |
2,167 |
$68K |
| D1351 |
Sealant - per tooth |
1,364 |
515 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,557 |
6,547 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
5,416 |
5,413 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
691 |
541 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,868 |
1,868 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,028 |
2,026 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
372 |
330 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
2,306 |
2,293 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,447 |
1,445 |
$16K |
| D0272 |
Bitewings - two radiographic images |
435 |
435 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
86 |
$4K |
| D0330 |
Panoramic radiographic image |
137 |
137 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
321 |
311 |
$3K |
| D9995 |
|
131 |
126 |
$3K |
| D2332 |
|
20 |
14 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
24 |
$962.16 |
| D9110 |
|
63 |
63 |
$856.96 |
| D2140 |
|
13 |
13 |
$554.00 |