| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,904 |
1,870 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
760 |
501 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
686 |
316 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,191 |
2,159 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,021 |
1,010 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
489 |
326 |
$27K |
| D1351 |
Sealant - per tooth |
992 |
180 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
451 |
433 |
$21K |
| D1120 |
Prophylaxis - child |
641 |
641 |
$19K |
| D0330 |
Panoramic radiographic image |
495 |
491 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
984 |
983 |
$18K |
| D2330 |
|
326 |
201 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
235 |
190 |
$17K |
| D2331 |
|
210 |
136 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
392 |
389 |
$8K |
| D0272 |
Bitewings - two radiographic images |
282 |
282 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
492 |
444 |
$4K |
| D2394 |
|
27 |
24 |
$2K |
| D2335 |
|
21 |
15 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$140.80 |
| D1999 |
|
270 |
252 |
$0.00 |