| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,111 |
6,110 |
$328K |
| D0274 |
Bitewings - four radiographic images |
5,493 |
5,493 |
$187K |
| D0120 |
Periodic oral evaluation - established patient |
6,517 |
6,517 |
$178K |
| D0330 |
Panoramic radiographic image |
2,074 |
2,073 |
$100K |
| D1120 |
Prophylaxis - child |
2,471 |
2,470 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,021 |
824 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,795 |
2,795 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,338 |
921 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,260 |
850 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,739 |
2,356 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,728 |
2,697 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,442 |
2,441 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,189 |
1,189 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
417 |
417 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,317 |
1,317 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
234 |
153 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,397 |
1,396 |
$23K |
| D2394 |
|
58 |
26 |
$8K |
| D2331 |
|
85 |
67 |
$7K |
| D1351 |
Sealant - per tooth |
205 |
58 |
$7K |
| D2332 |
|
41 |
27 |
$4K |
| D2330 |
|
18 |
13 |
$956.70 |
| D9110 |
|
16 |
16 |
$456.00 |
| D1999 |
|
46 |
45 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
270 |
260 |
$0.00 |