| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,197 |
2,964 |
$761K |
| D4910 |
|
1,474 |
1,385 |
$417K |
| D0140 |
Limited oral evaluation - problem focused |
1,191 |
1,085 |
$343K |
| D0120 |
Periodic oral evaluation - established patient |
1,695 |
1,587 |
$336K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,273 |
1,182 |
$331K |
| D0330 |
Panoramic radiographic image |
1,807 |
1,659 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
433 |
305 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
5,476 |
4,927 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,233 |
2,068 |
$27K |
| D4342 |
|
180 |
110 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
95 |
61 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
192 |
86 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,874 |
3,291 |
$5K |
| D1206 |
Topical application of fluoride varnish |
3,339 |
3,076 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$3K |
| D4341 |
|
18 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
15 |
15 |
$1K |
| D0604 |
|
319 |
266 |
$0.00 |