| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,224 |
3,821 |
$119K |
| D0210 |
Intraoral - complete series of radiographic images |
1,581 |
1,480 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
4,446 |
4,128 |
$70K |
| D1120 |
Prophylaxis - child |
2,509 |
2,329 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,855 |
2,494 |
$51K |
| D1206 |
Topical application of fluoride varnish |
3,665 |
3,402 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,405 |
2,124 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
777 |
467 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,203 |
1,083 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,343 |
1,195 |
$18K |
| D0330 |
Panoramic radiographic image |
305 |
260 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
228 |
129 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
942 |
828 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
106 |
65 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
103 |
55 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
204 |
198 |
$2K |
| D1351 |
Sealant - per tooth |
124 |
13 |
$2K |
| D1330 |
|
21 |
21 |
$0.00 |