| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,583 |
3,568 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
3,639 |
3,624 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
1,036 |
1,014 |
$40K |
| D0274 |
Bitewings - four radiographic images |
3,277 |
3,263 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,541 |
1,536 |
$33K |
| D1120 |
Prophylaxis - child |
789 |
787 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,455 |
4,398 |
$31K |
| D2752 |
|
55 |
36 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
5,069 |
4,982 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
257 |
140 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
419 |
415 |
$16K |
| D1206 |
Topical application of fluoride varnish |
350 |
350 |
$11K |
| D2954 |
|
94 |
80 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
93 |
48 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
120 |
53 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
59 |
24 |
$5K |
| D0330 |
Panoramic radiographic image |
73 |
73 |
$3K |
| D1351 |
Sealant - per tooth |
97 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
76 |
76 |
$775.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$770.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
26 |
$506.00 |