| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,522 |
2,512 |
$215K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,869 |
2,862 |
$183K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,250 |
878 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
1,805 |
1,795 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
2,212 |
2,206 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,426 |
828 |
$94K |
| D1120 |
Prophylaxis - child |
1,733 |
1,711 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,202 |
4,175 |
$58K |
| D9430 |
|
1,073 |
996 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
358 |
217 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,270 |
1,263 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,551 |
2,358 |
$18K |
| D9110 |
|
312 |
302 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,080 |
1,051 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
58 |
$8K |
| D1351 |
Sealant - per tooth |
188 |
42 |
$7K |
| D2330 |
|
43 |
17 |
$3K |
| D2332 |
|
23 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
16 |
$1K |
| D0350 |
|
124 |
55 |
$1K |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$333.00 |