| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,937 |
4,936 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
6,917 |
6,914 |
$136K |
| D0274 |
Bitewings - four radiographic images |
5,459 |
5,459 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
3,617 |
3,583 |
$69K |
| D1120 |
Prophylaxis - child |
2,152 |
2,151 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
908 |
713 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,358 |
6,299 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
4,437 |
4,436 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,429 |
3,428 |
$38K |
| D1351 |
Sealant - per tooth |
454 |
250 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
518 |
384 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
253 |
253 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
372 |
371 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
39 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
31 |
$1K |
| D1999 |
|
33 |
33 |
$0.00 |