| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,897 |
7,891 |
$300K |
| D0120 |
Periodic oral evaluation - established patient |
9,261 |
9,256 |
$202K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,400 |
1,942 |
$188K |
| D0274 |
Bitewings - four radiographic images |
7,392 |
7,391 |
$157K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,095 |
1,774 |
$132K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,066 |
10,031 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
10,434 |
10,352 |
$89K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
859 |
548 |
$61K |
| D4341 |
|
1,397 |
498 |
$57K |
| D1120 |
Prophylaxis - child |
1,393 |
1,392 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,733 |
3,732 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
3,065 |
3,018 |
$19K |
| D1351 |
Sealant - per tooth |
517 |
125 |
$18K |
| D2332 |
|
192 |
124 |
$15K |
| D2330 |
|
306 |
157 |
$14K |
| D2335 |
|
66 |
39 |
$6K |
| D2790 |
|
14 |
13 |
$5K |
| D0272 |
Bitewings - two radiographic images |
363 |
363 |
$5K |
| D2331 |
|
53 |
24 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
185 |
$4K |
| D2394 |
|
20 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
133 |
133 |
$2K |
| D2954 |
|
12 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
14 |
$900.00 |