| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,732 |
1,719 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,941 |
1,926 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,338 |
1,330 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
495 |
343 |
$30K |
| D0330 |
Panoramic radiographic image |
680 |
677 |
$25K |
| D1351 |
Sealant - per tooth |
982 |
121 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
830 |
827 |
$21K |
| D1120 |
Prophylaxis - child |
579 |
575 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
343 |
226 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
811 |
807 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
234 |
93 |
$15K |
| D9110 |
|
314 |
307 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,083 |
1,030 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
56 |
$5K |
| D0272 |
Bitewings - two radiographic images |
165 |
163 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
218 |
207 |
$2K |
| D1330 |
|
330 |
330 |
$2K |
| D2332 |
|
20 |
14 |
$1K |
| D0603 |
|
111 |
111 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$426.00 |
| D0602 |
|
16 |
16 |
$160.00 |
| D1999 |
|
17 |
17 |
$0.00 |