| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,843 |
9,325 |
$340K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,194 |
2,162 |
$269K |
| D0120 |
Periodic oral evaluation - established patient |
13,316 |
12,682 |
$235K |
| D0330 |
Panoramic radiographic image |
4,535 |
4,356 |
$202K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,073 |
1,924 |
$201K |
| D0274 |
Bitewings - four radiographic images |
7,734 |
7,289 |
$153K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,141 |
8,715 |
$142K |
| D1120 |
Prophylaxis - child |
6,595 |
6,296 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,021 |
3,777 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
4,036 |
3,715 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,443 |
593 |
$81K |
| D2335 |
|
494 |
197 |
$46K |
| D2331 |
|
800 |
353 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
374 |
220 |
$24K |
| D2330 |
|
567 |
214 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,918 |
2,710 |
$15K |
| D1351 |
Sealant - per tooth |
703 |
209 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,363 |
1,327 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
169 |
141 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
611 |
367 |
$3K |
| D1330 |
|
383 |
337 |
$0.00 |