| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,073 |
3,927 |
$219K |
| D0274 |
Bitewings - four radiographic images |
4,258 |
4,096 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,587 |
2,481 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
6,779 |
6,466 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
4,150 |
4,028 |
$103K |
| D1120 |
Prophylaxis - child |
2,001 |
1,938 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,200 |
3,098 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
1,921 |
1,837 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,698 |
5,118 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
516 |
345 |
$46K |
| D2740 |
Crown - porcelain/ceramic |
65 |
52 |
$45K |
| D1351 |
Sealant - per tooth |
1,009 |
265 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
333 |
205 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
132 |
126 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
40 |
$8K |
| D2950 |
|
37 |
27 |
$6K |
| D0330 |
Panoramic radiographic image |
84 |
81 |
$5K |
| D0272 |
Bitewings - two radiographic images |
82 |
80 |
$3K |
| D9430 |
|
15 |
12 |
$0.00 |