| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,049 |
7,044 |
$323K |
| D0120 |
Periodic oral evaluation - established patient |
9,122 |
9,113 |
$210K |
| D0274 |
Bitewings - four radiographic images |
8,118 |
8,118 |
$181K |
| D0220 |
Intraoral - periapical first radiographic image |
7,711 |
7,606 |
$84K |
| D1120 |
Prophylaxis - child |
2,020 |
2,016 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,726 |
7,725 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,903 |
3,898 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
707 |
644 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
535 |
476 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
736 |
724 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,586 |
1,540 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
231 |
215 |
$12K |
| D1351 |
Sealant - per tooth |
27 |
26 |
$3K |
| D4341 |
|
25 |
13 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
14 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
44 |
$1K |
| D1999 |
|
547 |
517 |
$0.00 |