| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,175 |
2,013 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,011 |
1,738 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
1,976 |
1,706 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,535 |
2,332 |
$74K |
| D1120 |
Prophylaxis - child |
2,323 |
2,002 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
556 |
338 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
968 |
904 |
$53K |
| D1206 |
Topical application of fluoride varnish |
2,700 |
2,378 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,061 |
973 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
307 |
112 |
$31K |
| D1330 |
|
986 |
968 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
409 |
163 |
$28K |
| D0330 |
Panoramic radiographic image |
587 |
517 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,746 |
2,275 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
86 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
233 |
93 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
996 |
785 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
495 |
471 |
$8K |
| D1351 |
Sealant - per tooth |
497 |
45 |
$7K |
| D2335 |
|
26 |
14 |
$4K |
| D0272 |
Bitewings - two radiographic images |
115 |
102 |
$2K |
| D2950 |
|
18 |
13 |
$2K |
| D0270 |
|
445 |
367 |
$2K |