| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,175 |
3,093 |
$118K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,056 |
724 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
4,390 |
4,279 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,180 |
722 |
$95K |
| D8670 |
Periodic orthodontic treatment visit |
889 |
838 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,349 |
3,268 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,570 |
1,517 |
$48K |
| D1120 |
Prophylaxis - child |
1,614 |
1,585 |
$43K |
| D0330 |
Panoramic radiographic image |
681 |
656 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,009 |
973 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
747 |
725 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
113 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,194 |
1,153 |
$17K |
| D0272 |
Bitewings - two radiographic images |
749 |
734 |
$13K |
| D2394 |
|
68 |
56 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
89 |
46 |
$5K |
| D2332 |
|
31 |
24 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$2K |
| D2331 |
|
16 |
12 |
$1K |
| D2330 |
|
17 |
13 |
$982.24 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$976.04 |
| D0230 |
Intraoral - periapical each additional radiographic image |
48 |
25 |
$584.42 |
| D1999 |
|
13 |
13 |
$0.00 |