| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,371 |
4,079 |
$177K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,970 |
1,704 |
$120K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,344 |
1,585 |
$119K |
| D0330 |
Panoramic radiographic image |
2,962 |
2,772 |
$117K |
| D1120 |
Prophylaxis - child |
1,894 |
1,818 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,330 |
3,092 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
4,330 |
4,096 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,132 |
908 |
$79K |
| D0272 |
Bitewings - two radiographic images |
3,149 |
2,966 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
4,344 |
3,925 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,269 |
1,167 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,117 |
2,048 |
$30K |
| D1351 |
Sealant - per tooth |
1,228 |
274 |
$20K |
| D2330 |
|
453 |
253 |
$19K |
| D2331 |
|
364 |
220 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,435 |
1,351 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
483 |
452 |
$13K |
| D1206 |
Topical application of fluoride varnish |
875 |
836 |
$12K |
| D9994 |
|
412 |
412 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
24 |
$2K |
| D2332 |
|
19 |
13 |
$1K |
| D0603 |
|
350 |
308 |
$0.00 |
| D1330 |
|
19 |
19 |
$0.00 |
| D1999 |
|
133 |
113 |
$0.00 |