| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,935 |
2,881 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,921 |
4,810 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,959 |
1,410 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,157 |
1,534 |
$89K |
| D0330 |
Panoramic radiographic image |
2,107 |
2,060 |
$82K |
| D1120 |
Prophylaxis - child |
1,599 |
1,571 |
$69K |
| D0272 |
Bitewings - two radiographic images |
3,900 |
3,818 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,216 |
3,144 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
760 |
487 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
984 |
915 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,238 |
1,954 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
431 |
430 |
$12K |
| D2331 |
|
207 |
158 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
163 |
146 |
$10K |
| D2330 |
|
144 |
102 |
$6K |
| D2332 |
|
44 |
26 |
$3K |
| D2335 |
|
26 |
13 |
$2K |
| D9110 |
|
13 |
13 |
$276.15 |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
26 |
$117.74 |
| D9986 |
|
21 |
21 |
$0.00 |