| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,259 |
4,095 |
$224K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,956 |
1,336 |
$220K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,950 |
2,803 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,987 |
850 |
$114K |
| D0330 |
Panoramic radiographic image |
2,639 |
2,518 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,985 |
4,779 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
2,785 |
2,713 |
$90K |
| D0274 |
Bitewings - four radiographic images |
4,223 |
4,064 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
370 |
208 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,927 |
3,704 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
762 |
728 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,673 |
2,840 |
$15K |
| D1351 |
Sealant - per tooth |
551 |
103 |
$13K |
| D1999 |
|
905 |
733 |
$11K |
| D1120 |
Prophylaxis - child |
449 |
437 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
159 |
76 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
70 |
39 |
$8K |
| D9630 |
|
67 |
66 |
$3K |
| D1206 |
Topical application of fluoride varnish |
89 |
87 |
$2K |
| D2330 |
|
17 |
12 |
$884.46 |
| D0273 |
|
30 |
28 |
$385.08 |
| D9430 |
|
87 |
83 |
$0.00 |