| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,400 |
5,387 |
$189K |
| D0120 |
Periodic oral evaluation - established patient |
6,727 |
6,711 |
$134K |
| D0274 |
Bitewings - four radiographic images |
5,142 |
5,134 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,253 |
7,238 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,685 |
752 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
6,228 |
6,211 |
$57K |
| D1120 |
Prophylaxis - child |
1,628 |
1,623 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
620 |
371 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,193 |
2,188 |
$24K |
| D2332 |
|
320 |
110 |
$20K |
| D1351 |
Sealant - per tooth |
468 |
122 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
306 |
159 |
$18K |
| D2750 |
|
56 |
40 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
821 |
817 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
755 |
754 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
295 |
145 |
$9K |
| D2330 |
|
216 |
120 |
$7K |
| D9990 |
|
309 |
309 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
507 |
502 |
$5K |
| D2954 |
|
46 |
42 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
41 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$5K |
| D4341 |
|
135 |
44 |
$5K |
| D1206 |
Topical application of fluoride varnish |
181 |
181 |
$4K |
| D0272 |
Bitewings - two radiographic images |
247 |
245 |
$3K |
| D2331 |
|
43 |
30 |
$2K |
| D2335 |
|
30 |
12 |
$2K |
| D9110 |
|
78 |
76 |
$1K |
| D0330 |
Panoramic radiographic image |
46 |
46 |
$1K |
| D9944 |
|
13 |
13 |
$1K |