| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,216 |
2,049 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,471 |
723 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
3,488 |
3,277 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
864 |
513 |
$40K |
| D1206 |
Topical application of fluoride varnish |
2,309 |
2,194 |
$32K |
| D1120 |
Prophylaxis - child |
1,721 |
1,652 |
$32K |
| D0330 |
Panoramic radiographic image |
663 |
572 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,339 |
1,255 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
363 |
219 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
669 |
609 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
485 |
446 |
$10K |
| D2931 |
|
112 |
72 |
$9K |
| D1351 |
Sealant - per tooth |
447 |
115 |
$9K |
| D0272 |
Bitewings - two radiographic images |
656 |
637 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
40 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
943 |
846 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
932 |
405 |
$4K |
| D1999 |
|
17 |
15 |
$0.00 |