| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,806 |
7,575 |
$308K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,963 |
1,813 |
$286K |
| D0120 |
Periodic oral evaluation - established patient |
10,415 |
10,193 |
$175K |
| D1120 |
Prophylaxis - child |
4,418 |
4,360 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,137 |
6,071 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,623 |
1,289 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,391 |
1,112 |
$91K |
| D0274 |
Bitewings - four radiographic images |
3,539 |
3,439 |
$82K |
| D0330 |
Panoramic radiographic image |
1,965 |
1,492 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,514 |
2,063 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
869 |
752 |
$36K |
| D9994 |
|
5,039 |
4,901 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,471 |
1,167 |
$25K |
| D2332 |
|
230 |
156 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,781 |
2,253 |
$21K |
| D1206 |
Topical application of fluoride varnish |
718 |
705 |
$13K |
| D1351 |
Sealant - per tooth |
351 |
96 |
$13K |
| D2330 |
|
152 |
103 |
$12K |
| D2331 |
|
116 |
88 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
91 |
77 |
$9K |
| D0272 |
Bitewings - two radiographic images |
124 |
124 |
$2K |
| D3120 |
|
40 |
32 |
$885.41 |
| D0230 |
Intraoral - periapical each additional radiographic image |
70 |
30 |
$469.56 |
| D1999 |
|
17 |
15 |
$0.00 |