| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,403 |
5,395 |
$222K |
| D0120 |
Periodic oral evaluation - established patient |
6,804 |
6,789 |
$147K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,355 |
7,351 |
$140K |
| D0220 |
Intraoral - periapical first radiographic image |
9,142 |
9,112 |
$129K |
| D1120 |
Prophylaxis - child |
3,744 |
3,739 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,443 |
955 |
$93K |
| D0272 |
Bitewings - two radiographic images |
5,639 |
5,633 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,591 |
5,582 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,520 |
2,519 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
913 |
605 |
$35K |
| D1351 |
Sealant - per tooth |
507 |
213 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
5,799 |
5,774 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
521 |
382 |
$20K |
| D2394 |
|
76 |
63 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
372 |
371 |
$4K |
| D1206 |
Topical application of fluoride varnish |
148 |
148 |
$4K |
| D0274 |
Bitewings - four radiographic images |
146 |
146 |
$3K |
| D2161 |
|
21 |
13 |
$3K |
| D2335 |
|
14 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$297.50 |
| D1999 |
|
46 |
44 |
$0.00 |