| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,423 |
8,417 |
$358K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,846 |
2,420 |
$228K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,011 |
2,035 |
$216K |
| D0274 |
Bitewings - four radiographic images |
8,082 |
8,082 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
7,694 |
7,691 |
$178K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,104 |
797 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
9,848 |
9,806 |
$84K |
| D1120 |
Prophylaxis - child |
1,918 |
1,918 |
$76K |
| D0160 |
|
1,938 |
1,938 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,195 |
9,178 |
$51K |
| D2335 |
|
548 |
292 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,374 |
3,373 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
2,982 |
2,976 |
$33K |
| D0330 |
Panoramic radiographic image |
1,013 |
1,009 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
732 |
731 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
927 |
922 |
$11K |
| D2332 |
|
126 |
63 |
$9K |
| D2954 |
|
52 |
38 |
$6K |
| D2750 |
|
15 |
12 |
$5K |
| D1351 |
Sealant - per tooth |
77 |
38 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
36 |
$2K |
| D0270 |
|
13 |
13 |
$109.58 |
| D1999 |
|
69 |
69 |
$0.00 |
| D1330 |
|
14 |
14 |
$0.00 |