| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,021 |
6,015 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
6,903 |
6,894 |
$134K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,339 |
1,572 |
$107K |
| D2750 |
|
260 |
180 |
$85K |
| D0274 |
Bitewings - four radiographic images |
4,098 |
4,096 |
$75K |
| D2331 |
|
716 |
596 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
5,021 |
4,966 |
$45K |
| D2954 |
|
377 |
320 |
$40K |
| D2330 |
|
827 |
588 |
$39K |
| D0330 |
Panoramic radiographic image |
1,551 |
1,550 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
422 |
351 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,175 |
4,170 |
$31K |
| D1120 |
Prophylaxis - child |
632 |
629 |
$19K |
| D2332 |
|
96 |
92 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
895 |
891 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
1,222 |
1,216 |
$9K |
| D9110 |
|
588 |
586 |
$9K |
| D2335 |
|
50 |
46 |
$6K |
| D3320 |
|
28 |
24 |
$6K |
| D2791 |
|
12 |
12 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
130 |
130 |
$3K |
| D2394 |
|
35 |
25 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
26 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
13 |
$679.00 |