| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,673 |
4,349 |
$169K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,459 |
901 |
$149K |
| D0330 |
Panoramic radiographic image |
2,784 |
2,566 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,395 |
3,017 |
$131K |
| D0274 |
Bitewings - four radiographic images |
3,951 |
3,633 |
$110K |
| D0140 |
Limited oral evaluation - problem focused |
3,313 |
2,978 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,612 |
4,229 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
6,123 |
5,382 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
2,863 |
2,773 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
894 |
612 |
$66K |
| D4355 |
|
781 |
704 |
$48K |
| D2331 |
|
435 |
227 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
416 |
106 |
$22K |
| D5110 |
|
31 |
28 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
149 |
71 |
$14K |
| D1206 |
Topical application of fluoride varnish |
743 |
714 |
$12K |
| D5120 |
|
12 |
12 |
$7K |
| D4341 |
|
79 |
28 |
$7K |
| D2330 |
|
90 |
54 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
68 |
$4K |
| D5212 |
|
16 |
12 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
15 |
$2K |
| D0270 |
|
268 |
256 |
$2K |
| D5410 |
|
74 |
67 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
99 |
$2K |
| D5411 |
|
42 |
38 |
$1K |
| D1330 |
|
177 |
158 |
$0.00 |