| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,228 |
3,742 |
$118K |
| D0210 |
Intraoral - complete series of radiographic images |
2,668 |
2,257 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
5,161 |
4,735 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,974 |
5,390 |
$107K |
| D0274 |
Bitewings - four radiographic images |
3,550 |
3,257 |
$100K |
| D1120 |
Prophylaxis - child |
2,420 |
2,222 |
$97K |
| D0140 |
Limited oral evaluation - problem focused |
3,373 |
3,011 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,741 |
2,171 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
478 |
248 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
461 |
217 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,658 |
1,461 |
$15K |
| D1351 |
Sealant - per tooth |
116 |
32 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
120 |
36 |
$4K |
| D9310 |
|
343 |
155 |
$3K |
| D0330 |
Panoramic radiographic image |
44 |
12 |
$175.74 |
| D0601 |
|
49 |
47 |
$0.00 |
| D0602 |
|
15 |
13 |
$0.00 |