| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,549 |
3,421 |
$157K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,923 |
5,693 |
$149K |
| D0330 |
Panoramic radiographic image |
3,302 |
3,162 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,243 |
1,581 |
$127K |
| D0274 |
Bitewings - four radiographic images |
4,183 |
4,019 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,450 |
980 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,838 |
1,276 |
$89K |
| D1120 |
Prophylaxis - child |
1,174 |
1,127 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
883 |
687 |
$50K |
| D2332 |
|
573 |
397 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,250 |
1,147 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
4,864 |
4,590 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,985 |
1,910 |
$29K |
| D2335 |
|
378 |
256 |
$27K |
| D2331 |
|
439 |
313 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
336 |
167 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
639 |
610 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,049 |
1,580 |
$13K |
| D2330 |
|
276 |
171 |
$11K |
| D2394 |
|
78 |
69 |
$5K |
| D1206 |
Topical application of fluoride varnish |
240 |
236 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
51 |
$2K |
| D0272 |
Bitewings - two radiographic images |
15 |
14 |
$196.56 |
| D1999 |
|
81 |
79 |
$0.00 |