| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,358 |
3,199 |
$176K |
| D2394 |
|
1,439 |
773 |
$168K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,135 |
2,919 |
$127K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,473 |
775 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,614 |
822 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,811 |
721 |
$123K |
| D0274 |
Bitewings - four radiographic images |
3,103 |
2,955 |
$106K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
777 |
448 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
2,603 |
2,290 |
$96K |
| D1120 |
Prophylaxis - child |
1,463 |
1,422 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
4,100 |
3,688 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,367 |
2,309 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,869 |
1,806 |
$54K |
| D2335 |
|
382 |
137 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,063 |
2,282 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
436 |
399 |
$27K |
| D1351 |
Sealant - per tooth |
439 |
110 |
$18K |
| D2332 |
|
179 |
68 |
$18K |
| D0330 |
Panoramic radiographic image |
437 |
425 |
$17K |
| D0272 |
Bitewings - two radiographic images |
519 |
499 |
$15K |
| D0270 |
|
632 |
597 |
$8K |
| D1330 |
|
15 |
15 |
$0.00 |