| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,694 |
9,659 |
$386K |
| D0120 |
Periodic oral evaluation - established patient |
10,649 |
10,612 |
$223K |
| D0272 |
Bitewings - two radiographic images |
11,016 |
10,998 |
$133K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,963 |
1,652 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,101 |
8,063 |
$115K |
| D0330 |
Panoramic radiographic image |
3,496 |
3,482 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
9,440 |
9,355 |
$94K |
| D1120 |
Prophylaxis - child |
1,705 |
1,700 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,178 |
973 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
4,278 |
4,049 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
320 |
278 |
$24K |
| D2954 |
|
229 |
209 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,065 |
1,064 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,087 |
2,078 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
259 |
201 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
268 |
265 |
$8K |
| D2330 |
|
87 |
67 |
$4K |
| D9110 |
|
261 |
256 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
46 |
42 |
$3K |
| D1351 |
Sealant - per tooth |
64 |
20 |
$3K |
| D2331 |
|
39 |
36 |
$3K |
| D0270 |
|
141 |
138 |
$1K |