| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,204 |
2,190 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
1,904 |
1,842 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,615 |
2,594 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
880 |
244 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,677 |
1,651 |
$54K |
| D0330 |
Panoramic radiographic image |
873 |
859 |
$51K |
| D1120 |
Prophylaxis - child |
1,270 |
1,257 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,013 |
2,001 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,712 |
1,343 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,931 |
1,837 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
371 |
356 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
65 |
$11K |
| D4355 |
|
92 |
86 |
$6K |
| D0272 |
Bitewings - two radiographic images |
227 |
225 |
$4K |
| D1206 |
Topical application of fluoride varnish |
191 |
188 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
57 |
12 |
$2K |
| D1999 |
|
56 |
54 |
$0.00 |