| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,076 |
4,025 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
4,340 |
4,290 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,579 |
897 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,024 |
1,999 |
$45K |
| D1120 |
Prophylaxis - child |
2,737 |
2,704 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,618 |
3,569 |
$36K |
| D0191 |
|
2,323 |
1,938 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
902 |
636 |
$33K |
| D0274 |
Bitewings - four radiographic images |
4,119 |
4,063 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
7,136 |
6,745 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,691 |
1,624 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,837 |
5,367 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
52 |
38 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
404 |
404 |
$11K |
| D0330 |
Panoramic radiographic image |
539 |
535 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
209 |
147 |
$6K |
| D0601 |
|
479 |
472 |
$3K |
| D0190 |
|
604 |
599 |
$3K |
| D1351 |
Sealant - per tooth |
258 |
31 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
26 |
$2K |
| D2954 |
|
18 |
15 |
$720.00 |
| D0270 |
|
108 |
105 |
$309.00 |
| D0602 |
|
59 |
58 |
$300.00 |
| D0603 |
|
85 |
83 |
$290.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$70.00 |
| D1330 |
|
848 |
835 |
$0.00 |
| D1999 |
|
2,483 |
2,068 |
$0.00 |