| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,944 |
8,834 |
$179K |
| D2752 |
|
499 |
413 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
8,440 |
8,349 |
$135K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,055 |
2,798 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,974 |
2,489 |
$114K |
| D0140 |
Limited oral evaluation - problem focused |
5,044 |
4,849 |
$97K |
| D0330 |
Panoramic radiographic image |
4,396 |
4,363 |
$83K |
| D1120 |
Prophylaxis - child |
3,549 |
3,517 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,824 |
4,780 |
$63K |
| D0274 |
Bitewings - four radiographic images |
7,494 |
7,405 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,359 |
978 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,107 |
4,056 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
10,573 |
10,318 |
$36K |
| D0602 |
|
7,702 |
7,587 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,474 |
9,065 |
$22K |
| D2954 |
|
140 |
124 |
$8K |
| D2332 |
|
107 |
80 |
$4K |
| D2335 |
|
51 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
213 |
38 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
43 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
24 |
$2K |
| D2330 |
|
38 |
27 |
$1K |
| D4355 |
|
13 |
13 |
$975.00 |
| D9110 |
|
91 |
84 |
$870.00 |
| D2331 |
|
19 |
14 |
$709.25 |
| D2394 |
|
17 |
14 |
$450.00 |
| D2940 |
|
16 |
14 |
$157.00 |