| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
11,223 |
11,210 |
$466K |
| D0120 |
Periodic oral evaluation - established patient |
17,661 |
17,637 |
$365K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,255 |
4,437 |
$308K |
| D0274 |
Bitewings - four radiographic images |
10,903 |
10,896 |
$214K |
| D0330 |
Panoramic radiographic image |
5,971 |
5,962 |
$183K |
| D0220 |
Intraoral - periapical first radiographic image |
12,516 |
12,487 |
$122K |
| D4341 |
|
1,699 |
676 |
$114K |
| D2750 |
|
171 |
155 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
838 |
621 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,920 |
10,907 |
$56K |
| D2954 |
|
483 |
446 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
2,528 |
2,514 |
$32K |
| D1120 |
Prophylaxis - child |
964 |
963 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
2,936 |
2,929 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,015 |
2,014 |
$22K |
| D3320 |
|
27 |
26 |
$9K |
| D0272 |
Bitewings - two radiographic images |
732 |
732 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
54 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
27 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
12 |
12 |
$1K |
| D1999 |
|
980 |
942 |
$0.00 |