| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,866 |
4,802 |
$187K |
| D0120 |
Periodic oral evaluation - established patient |
4,011 |
3,969 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,117 |
1,047 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,183 |
824 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,088 |
2,068 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
586 |
263 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,173 |
1,158 |
$37K |
| D0330 |
Panoramic radiographic image |
798 |
789 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
515 |
350 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
309 |
243 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,083 |
1,061 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
857 |
848 |
$17K |
| D1120 |
Prophylaxis - child |
592 |
583 |
$16K |
| D2394 |
|
68 |
60 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,291 |
1,233 |
$7K |
| D0272 |
Bitewings - two radiographic images |
330 |
326 |
$5K |
| D2335 |
|
17 |
13 |
$3K |
| D2332 |
|
16 |
14 |
$2K |
| D2330 |
|
19 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
279 |
242 |
$1K |
| D1999 |
|
115 |
105 |
$0.00 |