| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,526 |
3,446 |
$182K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,068 |
753 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,362 |
2,314 |
$106K |
| D1206 |
Topical application of fluoride varnish |
4,311 |
4,231 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
3,599 |
3,518 |
$96K |
| D1120 |
Prophylaxis - child |
1,976 |
1,937 |
$85K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
787 |
542 |
$70K |
| D1351 |
Sealant - per tooth |
1,859 |
255 |
$61K |
| D0330 |
Panoramic radiographic image |
1,249 |
1,221 |
$53K |
| D0274 |
Bitewings - four radiographic images |
2,394 |
2,351 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
2,727 |
2,642 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,191 |
2,014 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
67 |
$13K |
| D1330 |
|
1,947 |
1,913 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
243 |
235 |
$9K |
| D2750 |
|
16 |
13 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
227 |
225 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
37 |
$6K |
| D2950 |
|
35 |
28 |
$3K |
| D0272 |
Bitewings - two radiographic images |
150 |
150 |
$2K |
| D1999 |
|
13 |
13 |
$0.00 |