| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,769 |
4,505 |
$209K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,260 |
1,402 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
5,758 |
5,473 |
$117K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,493 |
568 |
$117K |
| D0274 |
Bitewings - four radiographic images |
2,787 |
2,620 |
$93K |
| D1206 |
Topical application of fluoride varnish |
4,288 |
4,062 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
2,129 |
2,009 |
$68K |
| D1120 |
Prophylaxis - child |
2,304 |
2,191 |
$62K |
| D0330 |
Panoramic radiographic image |
1,059 |
999 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,020 |
711 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,250 |
1,184 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
431 |
318 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,282 |
1,214 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,814 |
1,667 |
$20K |
| D2331 |
|
128 |
93 |
$14K |
| D1351 |
Sealant - per tooth |
774 |
197 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
555 |
492 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
275 |
201 |
$3K |
| D2394 |
|
16 |
14 |
$2K |
| D2332 |
|
20 |
15 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$670.94 |
| D1999 |
|
16 |
16 |
$0.00 |