| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,865 |
2,743 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,561 |
830 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
3,956 |
3,742 |
$99K |
| D1120 |
Prophylaxis - child |
2,080 |
1,936 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,300 |
3,104 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,127 |
2,045 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
577 |
358 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,449 |
2,330 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
431 |
262 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
726 |
703 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,086 |
1,730 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
357 |
342 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
580 |
554 |
$22K |
| D0330 |
Panoramic radiographic image |
374 |
360 |
$19K |
| D2332 |
|
53 |
30 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
26 |
$4K |
| D1351 |
Sealant - per tooth |
105 |
37 |
$3K |
| D0270 |
|
85 |
78 |
$1K |
| D0272 |
Bitewings - two radiographic images |
36 |
33 |
$832.00 |
| D2331 |
|
18 |
14 |
$674.00 |
| D1330 |
|
13 |
13 |
$0.00 |