| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,349 |
5,221 |
$325K |
| D0120 |
Periodic oral evaluation - established patient |
7,752 |
7,608 |
$228K |
| D1120 |
Prophylaxis - child |
4,323 |
4,248 |
$187K |
| D1206 |
Topical application of fluoride varnish |
6,817 |
6,687 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,517 |
990 |
$171K |
| D0140 |
Limited oral evaluation - problem focused |
2,809 |
2,655 |
$115K |
| D0330 |
Panoramic radiographic image |
1,894 |
1,854 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,662 |
1,612 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
651 |
407 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
686 |
436 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,761 |
1,719 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,766 |
1,727 |
$40K |
| D1351 |
Sealant - per tooth |
868 |
158 |
$29K |
| D1330 |
|
3,009 |
2,954 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
37 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
264 |
248 |
$3K |
| D2332 |
|
18 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$710.76 |
| D0230 |
Intraoral - periapical each additional radiographic image |
45 |
37 |
$546.43 |