| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,792 |
3,583 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
5,437 |
5,155 |
$84K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,284 |
3,134 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
927 |
618 |
$45K |
| D1120 |
Prophylaxis - child |
2,208 |
2,108 |
$42K |
| D0330 |
Panoramic radiographic image |
852 |
802 |
$35K |
| D8030 |
|
350 |
335 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
554 |
387 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
990 |
919 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
430 |
263 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,053 |
1,003 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
321 |
233 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
362 |
331 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
827 |
785 |
$16K |
| D1351 |
Sealant - per tooth |
467 |
139 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,298 |
1,206 |
$5K |
| D0272 |
Bitewings - two radiographic images |
550 |
522 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
13 |
13 |
$3K |
| D0340 |
|
42 |
42 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
42 |
28 |
$2K |
| D2394 |
|
16 |
12 |
$995.02 |
| D0470 |
|
42 |
42 |
$924.84 |
| D2140 |
|
23 |
13 |
$870.40 |
| D0350 |
|
42 |
42 |
$517.02 |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
52 |
$410.00 |