| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,954 |
4,954 |
$174K |
| D0274 |
Bitewings - four radiographic images |
6,139 |
6,139 |
$115K |
| D0210 |
Intraoral - complete series of radiographic images |
3,545 |
3,540 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
4,503 |
4,503 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,543 |
3,542 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
5,778 |
5,767 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
900 |
642 |
$49K |
| D1120 |
Prophylaxis - child |
828 |
828 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,825 |
4,746 |
$23K |
| D0330 |
Panoramic radiographic image |
1,088 |
1,087 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,735 |
1,728 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,378 |
1,378 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
134 |
40 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
268 |
153 |
$10K |
| D1351 |
Sealant - per tooth |
136 |
68 |
$9K |
| D9243 |
|
45 |
45 |
$6K |
| D0272 |
Bitewings - two radiographic images |
351 |
351 |
$4K |
| D9239 |
|
48 |
48 |
$3K |
| D0340 |
|
17 |
17 |
$557.13 |
| D9310 |
|
13 |
13 |
$544.68 |
| D0270 |
|
43 |
43 |
$396.46 |