| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,799 |
9,791 |
$353K |
| D0120 |
Periodic oral evaluation - established patient |
9,517 |
9,507 |
$183K |
| D0274 |
Bitewings - four radiographic images |
8,477 |
8,467 |
$164K |
| D0210 |
Intraoral - complete series of radiographic images |
5,624 |
5,620 |
$147K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,326 |
8,287 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
9,911 |
9,876 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,527 |
3,525 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,205 |
951 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
701 |
548 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
313 |
187 |
$20K |
| D1120 |
Prophylaxis - child |
492 |
492 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
688 |
688 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
944 |
932 |
$8K |
| D1351 |
Sealant - per tooth |
252 |
70 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
29 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
19 |
$1K |
| D1206 |
Topical application of fluoride varnish |
53 |
53 |
$1K |
| D0270 |
|
107 |
107 |
$817.92 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$309.85 |
| D1330 |
|
16 |
16 |
$0.00 |
| D1999 |
|
1,023 |
935 |
$0.00 |