| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,368 |
3,351 |
$127K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,212 |
853 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,365 |
2,358 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
2,352 |
2,340 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,753 |
1,745 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,872 |
2,863 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,668 |
1,667 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
3,286 |
3,272 |
$30K |
| D1120 |
Prophylaxis - child |
621 |
618 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
363 |
262 |
$18K |
| D4341 |
|
346 |
165 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
234 |
197 |
$17K |
| D9944 |
|
136 |
136 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
834 |
832 |
$10K |
| D0330 |
Panoramic radiographic image |
167 |
165 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
303 |
300 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
49 |
$3K |
| D2332 |
|
26 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
152 |
152 |
$2K |
| D2954 |
|
14 |
13 |
$1K |
| D9110 |
|
13 |
13 |
$172.52 |
| D1999 |
|
20 |
19 |
$0.00 |