| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,543 |
1,521 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,527 |
1,514 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
563 |
562 |
$30K |
| D1120 |
Prophylaxis - child |
658 |
648 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,027 |
1,010 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
471 |
456 |
$18K |
| D1206 |
Topical application of fluoride varnish |
555 |
549 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
162 |
103 |
$7K |
| D0274 |
Bitewings - four radiographic images |
1,183 |
1,168 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
2,044 |
1,969 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,474 |
1,504 |
$6K |
| D0330 |
Panoramic radiographic image |
846 |
832 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
46 |
25 |
$4K |
| D1351 |
Sealant - per tooth |
235 |
30 |
$4K |
| D0272 |
Bitewings - two radiographic images |
14 |
12 |
$132.00 |
| D0601 |
|
31 |
30 |
$110.00 |
| D0602 |
|
14 |
14 |
$40.00 |
| D1999 |
|
548 |
519 |
$0.00 |