| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,472 |
3,457 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,196 |
845 |
$122K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,408 |
639 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
4,206 |
4,185 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
853 |
528 |
$76K |
| D0330 |
Panoramic radiographic image |
1,581 |
1,563 |
$73K |
| D1351 |
Sealant - per tooth |
2,716 |
447 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,440 |
2,420 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,096 |
1,053 |
$51K |
| D1120 |
Prophylaxis - child |
1,204 |
1,197 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,290 |
1,275 |
$39K |
| D2394 |
|
227 |
190 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,260 |
1,258 |
$24K |
| D1330 |
|
1,924 |
1,916 |
$18K |
| D1310 |
|
1,862 |
1,854 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
156 |
136 |
$17K |
| D2330 |
|
178 |
105 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,360 |
1,312 |
$12K |
| D2331 |
|
126 |
91 |
$11K |
| D0272 |
Bitewings - two radiographic images |
502 |
501 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
531 |
531 |
$10K |
| D2335 |
|
88 |
57 |
$10K |
| D0601 |
|
52 |
52 |
$510.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
43 |
43 |
$425.52 |
| D1320 |
|
17 |
17 |
$237.60 |