| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,687 |
2,661 |
$127K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,260 |
3,933 |
$95K |
| D0330 |
Panoramic radiographic image |
1,653 |
1,634 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,889 |
2,867 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,339 |
471 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
2,892 |
2,875 |
$85K |
| D1206 |
Topical application of fluoride varnish |
2,898 |
2,873 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,898 |
1,833 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,367 |
4,221 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,285 |
607 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,815 |
1,794 |
$46K |
| D1120 |
Prophylaxis - child |
1,066 |
1,059 |
$30K |
| D4910 |
|
334 |
324 |
$26K |
| D4341 |
|
126 |
49 |
$20K |
| D1330 |
|
606 |
602 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
578 |
329 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
212 |
138 |
$7K |
| D1351 |
Sealant - per tooth |
184 |
45 |
$3K |
| D0272 |
Bitewings - two radiographic images |
114 |
114 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
13 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
14 |
$0.00 |