| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,815 |
4,784 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
5,219 |
5,190 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,299 |
828 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,443 |
795 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
2,569 |
2,522 |
$21K |
| D0274 |
Bitewings - four radiographic images |
3,066 |
3,051 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,496 |
1,488 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
782 |
504 |
$12K |
| D1120 |
Prophylaxis - child |
1,601 |
1,597 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
1,016 |
1,004 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
4,476 |
4,394 |
$9K |
| D2750 |
|
42 |
40 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,299 |
1,297 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,329 |
3,305 |
$5K |
| D1351 |
Sealant - per tooth |
287 |
28 |
$945.25 |
| D2954 |
|
43 |
37 |
$720.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$472.75 |
| D9910 |
|
141 |
141 |
$360.00 |
| D9211 |
|
71 |
68 |
$120.00 |
| D1330 |
|
37 |
37 |
$0.00 |