| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,563 |
4,527 |
$227K |
| D0120 |
Periodic oral evaluation - established patient |
5,856 |
5,821 |
$169K |
| D1206 |
Topical application of fluoride varnish |
4,816 |
4,792 |
$122K |
| D0274 |
Bitewings - four radiographic images |
2,998 |
2,976 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
5,534 |
5,360 |
$81K |
| D2722 |
|
58 |
27 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,828 |
4,512 |
$62K |
| D1120 |
Prophylaxis - child |
1,770 |
1,763 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
967 |
440 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,135 |
1,077 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,037 |
1,023 |
$29K |
| D0330 |
Panoramic radiographic image |
681 |
671 |
$28K |
| D1330 |
|
1,134 |
1,124 |
$24K |
| D0272 |
Bitewings - two radiographic images |
424 |
424 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
344 |
165 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
125 |
93 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
43 |
27 |
$3K |
| D1999 |
|
43 |
42 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
13 |
$0.00 |