| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,653 |
2,613 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
943 |
732 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,056 |
803 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,433 |
3,392 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
903 |
505 |
$97K |
| D1120 |
Prophylaxis - child |
1,917 |
1,883 |
$85K |
| D1206 |
Topical application of fluoride varnish |
3,143 |
3,098 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,303 |
1,278 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
279 |
231 |
$41K |
| D0330 |
Panoramic radiographic image |
898 |
883 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,710 |
1,687 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
600 |
581 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,182 |
1,148 |
$11K |
| D1351 |
Sealant - per tooth |
296 |
90 |
$10K |
| D2330 |
|
94 |
74 |
$9K |
| D1330 |
|
1,081 |
1,068 |
$6K |
| D0272 |
Bitewings - two radiographic images |
213 |
212 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
74 |
74 |
$3K |
| D2331 |
|
14 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
97 |
$931.76 |