| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
2,224 |
2,199 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,610 |
1,599 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,931 |
1,213 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
90 |
56 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
877 |
867 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
495 |
486 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,565 |
1,547 |
$0.00 |
| D2330 |
|
153 |
107 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
96 |
95 |
$0.00 |
| D1351 |
Sealant - per tooth |
151 |
72 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
462 |
329 |
$0.00 |
| D9920 |
|
331 |
322 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
118 |
111 |
$0.00 |
| D0603 |
|
73 |
73 |
$0.00 |
| D2331 |
|
79 |
63 |
$0.00 |
| D3310 |
|
53 |
42 |
$0.00 |
| D0602 |
|
69 |
69 |
$0.00 |
| D3320 |
|
123 |
110 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,396 |
936 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,715 |
1,696 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
450 |
437 |
$0.00 |
| D2950 |
|
1,031 |
830 |
$0.00 |
| D1120 |
Prophylaxis - child |
383 |
383 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
82 |
82 |
$0.00 |
| D2751 |
Crown - porcelain fused to predominantly base metal |
856 |
683 |
$0.00 |
| D4341 |
|
74 |
49 |
$0.00 |
| D2332 |
|
77 |
49 |
$0.00 |