| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,486 |
3,943 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,349 |
5,760 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
5,034 |
4,573 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
2,328 |
2,000 |
$101K |
| D1120 |
Prophylaxis - child |
2,343 |
2,204 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,517 |
764 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,156 |
2,866 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,545 |
2,090 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
3,103 |
2,727 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,113 |
471 |
$54K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
868 |
289 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
348 |
210 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,053 |
1,823 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
207 |
93 |
$12K |
| D9310 |
|
505 |
421 |
$8K |
| D2331 |
|
61 |
39 |
$4K |
| D0330 |
Panoramic radiographic image |
164 |
106 |
$2K |
| D1351 |
Sealant - per tooth |
55 |
17 |
$2K |
| D2330 |
|
59 |
29 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
206 |
111 |
$2K |
| D0272 |
Bitewings - two radiographic images |
59 |
56 |
$2K |
| D2950 |
|
47 |
13 |
$823.36 |
| D0270 |
|
54 |
43 |
$252.28 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$180.32 |