| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,092 |
4,041 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,018 |
2,304 |
$162K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,030 |
3,968 |
$103K |
| D0274 |
Bitewings - four radiographic images |
3,854 |
3,804 |
$95K |
| D0330 |
Panoramic radiographic image |
2,212 |
2,171 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,081 |
1,579 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,309 |
1,117 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,787 |
795 |
$65K |
| D2335 |
|
507 |
337 |
$37K |
| D2394 |
|
404 |
351 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
676 |
655 |
$19K |
| D2332 |
|
233 |
160 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
691 |
682 |
$14K |
| D1120 |
Prophylaxis - child |
317 |
306 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
947 |
925 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
247 |
238 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
491 |
244 |
$2K |
| D2330 |
|
15 |
12 |
$662.20 |
| D1330 |
|
877 |
852 |
$0.00 |