| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,160 |
3,017 |
$132K |
| D1120 |
Prophylaxis - child |
2,358 |
2,297 |
$118K |
| D0330 |
Panoramic radiographic image |
2,818 |
2,676 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,841 |
1,104 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,284 |
3,210 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,732 |
751 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,536 |
2,402 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,425 |
2,293 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,793 |
1,687 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,683 |
2,613 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
561 |
346 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
625 |
414 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
380 |
193 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,724 |
1,616 |
$13K |
| D0272 |
Bitewings - two radiographic images |
667 |
658 |
$12K |
| D1321 |
|
660 |
655 |
$10K |
| D1351 |
Sealant - per tooth |
327 |
91 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
180 |
167 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38 |
27 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
86 |
53 |
$469.23 |
| D9996 |
|
51 |
50 |
$0.00 |