| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
32,816 |
32,780 |
$1.13M |
| D0120 |
Periodic oral evaluation - established patient |
37,672 |
37,638 |
$754K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,745 |
5,063 |
$647K |
| D0274 |
Bitewings - four radiographic images |
23,981 |
23,974 |
$466K |
| D0220 |
Intraoral - periapical first radiographic image |
42,042 |
41,774 |
$381K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,760 |
35,694 |
$350K |
| D0210 |
Intraoral - complete series of radiographic images |
17,066 |
16,873 |
$299K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,248 |
4,308 |
$294K |
| D1120 |
Prophylaxis - child |
7,123 |
7,114 |
$250K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,431 |
2,059 |
$149K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,182 |
10,172 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,731 |
5,723 |
$120K |
| D1351 |
Sealant - per tooth |
1,001 |
548 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
7,079 |
6,957 |
$67K |
| D2332 |
|
1,043 |
421 |
$57K |
| D2750 |
|
121 |
108 |
$42K |
| D1320 |
|
4,206 |
4,197 |
$33K |
| D2954 |
|
283 |
249 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
303 |
265 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
287 |
240 |
$12K |
| D2330 |
|
248 |
170 |
$9K |
| D0272 |
Bitewings - two radiographic images |
607 |
606 |
$8K |
| D2331 |
|
84 |
71 |
$5K |
| D2335 |
|
47 |
43 |
$4K |
| D0330 |
Panoramic radiographic image |
109 |
109 |
$3K |
| D3320 |
|
13 |
12 |
$1K |
| D0270 |
|
96 |
96 |
$854.16 |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$603.50 |
| D9110 |
|
38 |
38 |
$548.70 |
| D1330 |
|
36 |
36 |
$0.00 |