| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,008 |
9,006 |
$314K |
| D0120 |
Periodic oral evaluation - established patient |
11,315 |
11,306 |
$232K |
| D0274 |
Bitewings - four radiographic images |
7,041 |
7,040 |
$140K |
| D0210 |
Intraoral - complete series of radiographic images |
4,292 |
4,287 |
$123K |
| D2750 |
|
296 |
229 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,345 |
1,649 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,446 |
1,121 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,259 |
8,233 |
$73K |
| D2952 |
|
873 |
747 |
$73K |
| D1120 |
Prophylaxis - child |
1,715 |
1,714 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
7,758 |
7,755 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,799 |
2,799 |
$38K |
| D1351 |
Sealant - per tooth |
371 |
204 |
$28K |
| D1320 |
|
2,681 |
2,680 |
$21K |
| D2335 |
|
266 |
184 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
256 |
206 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
103 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
121 |
110 |
$7K |
| D2790 |
|
26 |
26 |
$6K |
| D3320 |
|
16 |
14 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
307 |
306 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
40 |
$842.84 |
| D2330 |
|
18 |
12 |
$414.08 |
| D1999 |
|
125 |
116 |
$0.00 |