| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,607 |
1,585 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,938 |
1,896 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
420 |
279 |
$26K |
| D0274 |
Bitewings - four radiographic images |
817 |
806 |
$23K |
| D1120 |
Prophylaxis - child |
574 |
557 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
910 |
882 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
291 |
184 |
$16K |
| D1351 |
Sealant - per tooth |
697 |
110 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
318 |
301 |
$15K |
| D0330 |
Panoramic radiographic image |
338 |
336 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
87 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
316 |
$7K |
| D0272 |
Bitewings - two radiographic images |
227 |
224 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
365 |
339 |
$3K |
| D2331 |
|
42 |
26 |
$2K |
| D2330 |
|
35 |
24 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
15 |
$1K |
| D2335 |
|
18 |
12 |
$1K |
| D2332 |
|
18 |
12 |
$1K |
| D1999 |
|
237 |
229 |
$0.00 |