| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
15,909 |
15,888 |
$659K |
| D0120 |
Periodic oral evaluation - established patient |
18,362 |
18,336 |
$412K |
| D0274 |
Bitewings - four radiographic images |
15,944 |
15,937 |
$349K |
| D1120 |
Prophylaxis - child |
3,715 |
3,710 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,840 |
1,446 |
$129K |
| D0220 |
Intraoral - periapical first radiographic image |
14,911 |
14,834 |
$128K |
| D2740 |
Crown - porcelain/ceramic |
271 |
217 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,934 |
1,470 |
$99K |
| D0210 |
Intraoral - complete series of radiographic images |
3,177 |
3,162 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,104 |
1,649 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,839 |
15,810 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,077 |
5,074 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,147 |
2,145 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,274 |
1,252 |
$15K |
| D0330 |
Panoramic radiographic image |
283 |
282 |
$8K |
| D2954 |
|
43 |
38 |
$5K |
| D2332 |
|
13 |
12 |
$980.26 |
| D2331 |
|
14 |
13 |
$654.59 |
| D1330 |
|
614 |
614 |
$0.00 |
| D1999 |
|
41 |
41 |
$0.00 |