| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,321 |
2,904 |
$158K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,866 |
1,035 |
$145K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,264 |
751 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,366 |
515 |
$118K |
| D0330 |
Panoramic radiographic image |
1,775 |
1,551 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
4,141 |
3,641 |
$102K |
| D0274 |
Bitewings - four radiographic images |
3,015 |
2,629 |
$79K |
| D2394 |
|
427 |
253 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,381 |
1,263 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,290 |
2,045 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,449 |
2,861 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,331 |
1,158 |
$39K |
| D1120 |
Prophylaxis - child |
1,312 |
1,178 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
4,630 |
4,017 |
$33K |
| D2740 |
Crown - porcelain/ceramic |
23 |
14 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
224 |
127 |
$17K |
| D1206 |
Topical application of fluoride varnish |
295 |
286 |
$9K |
| D4341 |
|
32 |
12 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
55 |
$4K |
| D0272 |
Bitewings - two radiographic images |
200 |
189 |
$3K |
| D2950 |
|
16 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
42 |
14 |
$858.00 |