| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,858 |
1,834 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,527 |
1,521 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
228 |
228 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,022 |
1,007 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
343 |
248 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
562 |
544 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
1,649 |
1,631 |
$4K |
| D1120 |
Prophylaxis - child |
471 |
467 |
$3K |
| D0330 |
Panoramic radiographic image |
1,298 |
1,287 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,646 |
1,589 |
$2K |
| D1206 |
Topical application of fluoride varnish |
595 |
586 |
$2K |
| D1351 |
Sealant - per tooth |
272 |
66 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
109 |
53 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$720.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
29 |
$720.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,262 |
693 |
$603.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
30 |
$576.00 |
| D0272 |
Bitewings - two radiographic images |
99 |
98 |
$496.00 |
| D1999 |
|
991 |
869 |
$0.00 |
| D2999 |
|
14 |
13 |
$0.00 |