| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,886 |
3,749 |
$120K |
| D0274 |
Bitewings - four radiographic images |
3,924 |
3,792 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,143 |
758 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,628 |
2,520 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
4,404 |
4,222 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,613 |
1,576 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,033 |
3,850 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
494 |
202 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
641 |
397 |
$28K |
| D1351 |
Sealant - per tooth |
574 |
97 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
191 |
142 |
$11K |
| D9110 |
|
349 |
322 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
139 |
132 |
$6K |
| D0601 |
|
444 |
440 |
$4K |
| D4341 |
|
34 |
25 |
$3K |
| D1330 |
|
494 |
487 |
$3K |
| D1310 |
|
396 |
390 |
$2K |
| D1120 |
Prophylaxis - child |
57 |
56 |
$1K |
| D1320 |
|
81 |
79 |
$1K |
| D2331 |
|
20 |
15 |
$861.74 |
| D1206 |
Topical application of fluoride varnish |
50 |
50 |
$859.41 |
| D1208 |
Topical application of fluoride, excluding varnish |
44 |
44 |
$712.38 |
| D2330 |
|
13 |
13 |
$547.71 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$401.08 |