| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,114 |
10,098 |
$291K |
| D0120 |
Periodic oral evaluation - established patient |
10,808 |
10,794 |
$190K |
| D0274 |
Bitewings - four radiographic images |
8,578 |
8,570 |
$145K |
| D0220 |
Intraoral - periapical first radiographic image |
12,930 |
12,802 |
$104K |
| D1120 |
Prophylaxis - child |
3,110 |
3,110 |
$104K |
| D2750 |
|
287 |
172 |
$104K |
| D9310 |
|
1,613 |
1,612 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
2,448 |
2,434 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,823 |
1,272 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,472 |
10,444 |
$50K |
| D1351 |
Sealant - per tooth |
1,163 |
313 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
986 |
784 |
$44K |
| D4341 |
|
970 |
410 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,166 |
2,166 |
$26K |
| D1206 |
Topical application of fluoride varnish |
978 |
978 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,186 |
1,186 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
321 |
199 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,986 |
1,953 |
$16K |
| D8670 |
Periodic orthodontic treatment visit |
67 |
67 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
218 |
170 |
$12K |
| D0340 |
|
268 |
267 |
$10K |
| D0330 |
Panoramic radiographic image |
344 |
343 |
$8K |
| D8660 |
|
266 |
265 |
$6K |
| D9110 |
|
434 |
429 |
$5K |
| D0350 |
|
440 |
439 |
$4K |
| D0470 |
|
95 |
95 |
$2K |
| D9944 |
|
24 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$362.63 |
| D0240 |
|
31 |
30 |
$199.31 |
| D0601 |
|
187 |
187 |
$183.00 |
| D1999 |
|
1,505 |
1,373 |
$0.00 |