| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,910 |
2,718 |
$104K |
| D0330 |
Panoramic radiographic image |
1,903 |
1,788 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,177 |
728 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,825 |
1,672 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
2,512 |
2,348 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
986 |
580 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,882 |
1,766 |
$37K |
| D1120 |
Prophylaxis - child |
947 |
873 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,451 |
1,359 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
420 |
220 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,083 |
1,007 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,165 |
1,967 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
228 |
159 |
$13K |
| D0272 |
Bitewings - two radiographic images |
701 |
642 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
227 |
120 |
$8K |
| D2331 |
|
117 |
71 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
107 |
104 |
$5K |
| D2332 |
|
71 |
43 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
844 |
532 |
$3K |
| D1206 |
Topical application of fluoride varnish |
154 |
145 |
$2K |
| D2330 |
|
48 |
25 |
$2K |
| D1351 |
Sealant - per tooth |
84 |
27 |
$1K |
| D9110 |
|
27 |
23 |
$520.80 |
| D0270 |
|
61 |
56 |
$335.00 |
| D1999 |
|
98 |
92 |
$0.00 |