| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,567 |
5,556 |
$144K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,599 |
1,012 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,464 |
1,116 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
4,304 |
4,297 |
$60K |
| D0274 |
Bitewings - four radiographic images |
4,187 |
4,181 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,744 |
1,238 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
1,433 |
1,428 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
6,163 |
6,004 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,733 |
1,729 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,689 |
1,657 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,784 |
3,687 |
$15K |
| D1120 |
Prophylaxis - child |
421 |
421 |
$14K |
| D4341 |
|
507 |
219 |
$14K |
| D9110 |
|
657 |
647 |
$5K |
| D2332 |
|
97 |
52 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
86 |
57 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
297 |
297 |
$3K |
| D9310 |
|
91 |
91 |
$3K |
| D0330 |
Panoramic radiographic image |
102 |
102 |
$2K |
| D2335 |
|
21 |
12 |
$1K |
| D2330 |
|
39 |
27 |
$1K |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$480.00 |
| D0270 |
|
14 |
14 |
$79.90 |
| D1999 |
|
713 |
643 |
$0.00 |
| D1310 |
|
229 |
228 |
$0.00 |
| D1330 |
|
228 |
227 |
$0.00 |