| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,501 |
2,326 |
$133K |
| D0274 |
Bitewings - four radiographic images |
2,306 |
2,173 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,657 |
1,543 |
$69K |
| D1351 |
Sealant - per tooth |
1,979 |
230 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
574 |
335 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,641 |
1,551 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
374 |
208 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,702 |
2,521 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,338 |
2,534 |
$38K |
| D0330 |
Panoramic radiographic image |
521 |
486 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
124 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
304 |
283 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
557 |
503 |
$11K |
| D4346 |
|
63 |
56 |
$6K |
| D2332 |
|
39 |
25 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
12 |
$4K |
| D1206 |
Topical application of fluoride varnish |
128 |
122 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
26 |
$2K |
| D2394 |
|
15 |
12 |
$2K |
| D1999 |
|
30 |
21 |
$15.00 |