| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,071 |
7,064 |
$247K |
| D0120 |
Periodic oral evaluation - established patient |
7,222 |
7,216 |
$142K |
| D0274 |
Bitewings - four radiographic images |
6,276 |
6,270 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
4,576 |
4,526 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,734 |
1,053 |
$104K |
| D1351 |
Sealant - per tooth |
1,788 |
771 |
$93K |
| D1120 |
Prophylaxis - child |
2,071 |
2,070 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,428 |
7,346 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,490 |
802 |
$60K |
| D9945 |
|
642 |
641 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
5,494 |
5,488 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,046 |
2,046 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
576 |
374 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,289 |
3,288 |
$36K |
| D2332 |
|
409 |
239 |
$30K |
| D2335 |
|
315 |
211 |
$29K |
| D1206 |
Topical application of fluoride varnish |
447 |
447 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
1,016 |
1,013 |
$9K |
| D1320 |
|
1,027 |
1,027 |
$8K |
| D9110 |
|
392 |
390 |
$6K |
| D9940 |
|
45 |
44 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
63 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
16 |
$2K |
| D2954 |
|
14 |
14 |
$1K |
| D4341 |
|
30 |
13 |
$1K |
| D9310 |
|
12 |
12 |
$558.60 |
| D9430 |
|
15 |
15 |
$213.06 |
| D0270 |
|
13 |
13 |
$116.40 |
| D1999 |
|
48 |
47 |
$0.00 |