| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,215 |
4,565 |
$204K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,531 |
1,488 |
$160K |
| D1351 |
Sealant - per tooth |
7,320 |
1,036 |
$151K |
| D0274 |
Bitewings - four radiographic images |
4,123 |
3,503 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
5,687 |
4,914 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,776 |
1,561 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,676 |
1,065 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,644 |
4,033 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,019 |
1,680 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
2,129 |
1,804 |
$60K |
| D0330 |
Panoramic radiographic image |
1,980 |
1,582 |
$57K |
| D1120 |
Prophylaxis - child |
2,178 |
1,893 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
642 |
426 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
252 |
126 |
$21K |
| D4355 |
|
166 |
143 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,562 |
1,266 |
$14K |
| D0272 |
Bitewings - two radiographic images |
439 |
374 |
$5K |
| D2331 |
|
34 |
24 |
$3K |
| D1999 |
|
361 |
315 |
$120.48 |
| D1330 |
|
247 |
215 |
$0.00 |