| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,826 |
4,820 |
$262K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,782 |
2,195 |
$239K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,356 |
1,142 |
$141K |
| D0274 |
Bitewings - four radiographic images |
4,804 |
4,799 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
4,648 |
4,642 |
$128K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,043 |
1,483 |
$121K |
| D1120 |
Prophylaxis - child |
2,258 |
2,256 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,666 |
2,662 |
$78K |
| D0330 |
Panoramic radiographic image |
1,774 |
1,773 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,634 |
2,630 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
2,000 |
1,963 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
779 |
776 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,256 |
1,233 |
$16K |
| D2394 |
|
91 |
81 |
$14K |
| D0272 |
Bitewings - two radiographic images |
507 |
507 |
$8K |
| D1206 |
Topical application of fluoride varnish |
91 |
91 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
38 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
26 |
$2K |
| D2332 |
|
16 |
12 |
$2K |
| D9986 |
|
101 |
93 |
$0.00 |