| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,736 |
4,291 |
$202K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,911 |
5,314 |
$131K |
| D0330 |
Panoramic radiographic image |
5,151 |
4,595 |
$121K |
| D1351 |
Sealant - per tooth |
2,286 |
555 |
$114K |
| D1120 |
Prophylaxis - child |
2,636 |
2,362 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
3,073 |
2,782 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,454 |
584 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
911 |
436 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,029 |
1,829 |
$52K |
| D0272 |
Bitewings - two radiographic images |
5,075 |
4,548 |
$41K |
| D9110 |
|
751 |
722 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
551 |
416 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,789 |
1,555 |
$31K |
| D2940 |
|
2,317 |
1,517 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,343 |
1,244 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
188 |
166 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
890 |
747 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
430 |
408 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
15 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
35 |
34 |
$1K |
| D9995 |
|
31 |
15 |
$13.19 |