| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,205 |
5,172 |
$538K |
| D0140 |
Limited oral evaluation - problem focused |
4,117 |
3,997 |
$470K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,425 |
2,131 |
$379K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,817 |
2,093 |
$338K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,593 |
2,572 |
$243K |
| D0120 |
Periodic oral evaluation - established patient |
4,434 |
4,415 |
$238K |
| D1120 |
Prophylaxis - child |
3,916 |
3,910 |
$159K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,713 |
1,241 |
$158K |
| D4355 |
|
760 |
758 |
$110K |
| D1206 |
Topical application of fluoride varnish |
4,346 |
4,335 |
$106K |
| D1351 |
Sealant - per tooth |
3,680 |
943 |
$91K |
| D0274 |
Bitewings - four radiographic images |
3,042 |
3,018 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
1,319 |
1,294 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
357 |
312 |
$50K |
| D0330 |
Panoramic radiographic image |
1,837 |
1,809 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,566 |
3,479 |
$41K |
| D0191 |
|
1,978 |
1,955 |
$21K |
| D0272 |
Bitewings - two radiographic images |
485 |
483 |
$9K |
| D2330 |
|
71 |
53 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,095 |
713 |
$4K |
| D7250 |
|
35 |
24 |
$3K |
| D2331 |
|
18 |
12 |
$1K |
| D0270 |
|
80 |
80 |
$342.48 |
| D0603 |
|
351 |
348 |
$25.00 |
| D0602 |
|
243 |
243 |
$20.00 |
| D0601 |
|
244 |
244 |
$10.00 |