| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,853 |
2,604 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,193 |
665 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,623 |
2,069 |
$55K |
| D0330 |
Panoramic radiographic image |
1,454 |
973 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
1,264 |
1,086 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
567 |
382 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,978 |
1,830 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,883 |
1,812 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,384 |
1,370 |
$22K |
| D1120 |
Prophylaxis - child |
793 |
781 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
961 |
715 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
166 |
53 |
$11K |
| D1351 |
Sealant - per tooth |
187 |
55 |
$6K |
| D9630 |
|
1,141 |
1,141 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
468 |
336 |
$3K |
| D9994 |
|
828 |
826 |
$0.00 |
| D0701 |
|
27 |
26 |
$0.00 |