| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,626 |
6,511 |
$455K |
| D0120 |
Periodic oral evaluation - established patient |
8,631 |
8,477 |
$274K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,884 |
9,707 |
$238K |
| D4210 |
|
459 |
143 |
$160K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,531 |
2,411 |
$127K |
| D1120 |
Prophylaxis - child |
2,566 |
2,518 |
$116K |
| D4341 |
|
772 |
224 |
$107K |
| D9310 |
|
1,165 |
1,159 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
979 |
968 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
3,566 |
3,467 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
195 |
137 |
$29K |
| D0272 |
Bitewings - two radiographic images |
569 |
546 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
458 |
453 |
$21K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
26 |
25 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
74 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
29 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
18 |
$6K |
| D1351 |
Sealant - per tooth |
92 |
28 |
$3K |
| D0330 |
Panoramic radiographic image |
49 |
49 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
31 |
31 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,965 |
1,965 |
$0.00 |
| D2950 |
|
16 |
12 |
$0.00 |