| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,937 |
3,787 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,406 |
1,801 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,960 |
4,695 |
$122K |
| D1120 |
Prophylaxis - child |
2,247 |
2,147 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,034 |
1,402 |
$87K |
| D0330 |
Panoramic radiographic image |
2,077 |
1,992 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,635 |
1,042 |
$79K |
| D2335 |
|
1,051 |
729 |
$74K |
| D0274 |
Bitewings - four radiographic images |
2,328 |
2,236 |
$58K |
| D9110 |
|
1,351 |
1,276 |
$56K |
| D0272 |
Bitewings - two radiographic images |
3,143 |
2,987 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,695 |
1,688 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
5,402 |
5,035 |
$44K |
| D2332 |
|
473 |
358 |
$32K |
| D2330 |
|
692 |
449 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
428 |
378 |
$25K |
| D2331 |
|
422 |
305 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
719 |
666 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,043 |
946 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,493 |
1,456 |
$13K |
| D0270 |
|
16 |
13 |
$75.46 |
| 888888 |
|
58 |
48 |
$0.00 |