| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,367 |
6,274 |
$433K |
| D0120 |
Periodic oral evaluation - established patient |
8,057 |
7,950 |
$256K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,868 |
9,725 |
$234K |
| D0330 |
Panoramic radiographic image |
3,118 |
3,068 |
$215K |
| D1120 |
Prophylaxis - child |
3,129 |
3,096 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
974 |
592 |
$132K |
| D0272 |
Bitewings - two radiographic images |
3,754 |
3,706 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,798 |
1,769 |
$119K |
| D0350 |
|
2,350 |
2,286 |
$116K |
| D0140 |
Limited oral evaluation - problem focused |
1,686 |
1,583 |
$76K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
336 |
236 |
$53K |
| D1351 |
Sealant - per tooth |
1,333 |
387 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
463 |
293 |
$47K |
| D2750 |
|
86 |
63 |
$40K |
| D4910 |
|
534 |
516 |
$36K |
| D9110 |
|
295 |
266 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
856 |
778 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
65 |
$12K |
| D4341 |
|
56 |
14 |
$8K |
| D2952 |
|
68 |
36 |
$7K |
| D0460 |
|
13 |
12 |
$239.76 |
| D0601 |
|
131 |
131 |
$0.01 |
| D0602 |
|
117 |
117 |
$0.00 |
| D0603 |
|
26 |
26 |
$0.00 |