| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,827 |
1,821 |
$373K |
| D0140 |
Limited oral evaluation - problem focused |
1,335 |
1,314 |
$302K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,301 |
855 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
2,263 |
2,260 |
$192K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
452 |
451 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
293 |
227 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
306 |
223 |
$49K |
| D1206 |
Topical application of fluoride varnish |
1,001 |
995 |
$22K |
| D1120 |
Prophylaxis - child |
574 |
568 |
$21K |
| D0274 |
Bitewings - four radiographic images |
581 |
581 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,110 |
1,091 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
233 |
232 |
$10K |
| D0330 |
Panoramic radiographic image |
149 |
148 |
$3K |
| D2331 |
|
16 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$250.00 |
| D0602 |
|
257 |
254 |
$0.00 |
| D0603 |
|
36 |
36 |
$0.00 |
| D0601 |
|
13 |
12 |
$0.00 |