| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,506 |
4,503 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,907 |
2,072 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,963 |
1,932 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
5,181 |
5,179 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,444 |
5,441 |
$79K |
| D0274 |
Bitewings - four radiographic images |
3,348 |
3,346 |
$62K |
| D1120 |
Prophylaxis - child |
897 |
896 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,596 |
1,595 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
1,239 |
1,239 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,424 |
1,423 |
$13K |
| D2331 |
|
116 |
80 |
$6K |
| D9990 |
|
250 |
224 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
185 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
121 |
99 |
$4K |
| D0272 |
Bitewings - two radiographic images |
239 |
239 |
$3K |
| D2330 |
|
48 |
27 |
$2K |
| D1351 |
Sealant - per tooth |
43 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
36 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
36 |
$263.78 |