| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,110 |
2,042 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,876 |
2,776 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,676 |
888 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,845 |
1,776 |
$66K |
| D1120 |
Prophylaxis - child |
1,975 |
1,903 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,319 |
3,245 |
$47K |
| D0274 |
Bitewings - four radiographic images |
3,267 |
3,168 |
$36K |
| D0330 |
Panoramic radiographic image |
2,072 |
1,999 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
4,112 |
3,891 |
$29K |
| D1206 |
Topical application of fluoride varnish |
826 |
796 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
514 |
251 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,488 |
3,605 |
$12K |
| D9430 |
|
588 |
540 |
$12K |
| D9999 |
Unspecified adjunctive procedure, by report |
71 |
71 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
118 |
81 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
111 |
54 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
98 |
27 |
$2K |
| D1310 |
|
670 |
647 |
$966.00 |
| D4341 |
|
39 |
13 |
$460.00 |
| D0603 |
|
437 |
413 |
$404.00 |
| D0350 |
|
43 |
15 |
$60.00 |
| D1330 |
|
1,798 |
1,726 |
$0.00 |
| D9992 |
|
16 |
16 |
$0.00 |
| D9994 |
|
31 |
31 |
$0.00 |
| D9993 |
|
361 |
345 |
$0.00 |
| D9986 |
|
174 |
168 |
$0.00 |