| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
9,529 |
8,432 |
$256K |
| D1110 |
Prophylaxis - adult |
7,160 |
6,207 |
$216K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,882 |
1,812 |
$198K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,892 |
1,647 |
$168K |
| D0330 |
Panoramic radiographic image |
3,205 |
2,878 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
6,751 |
6,092 |
$145K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,156 |
6,241 |
$138K |
| D1120 |
Prophylaxis - child |
3,159 |
2,949 |
$126K |
| D0140 |
Limited oral evaluation - problem focused |
4,139 |
3,842 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,910 |
2,434 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
5,987 |
5,291 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,102 |
2,557 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
422 |
315 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
300 |
247 |
$15K |
| D2791 |
|
29 |
27 |
$14K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
20 |
13 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
37 |
$6K |
| D2332 |
|
66 |
48 |
$5K |
| D2394 |
|
30 |
25 |
$3K |
| D9310 |
|
121 |
120 |
$2K |
| D0602 |
|
410 |
405 |
$0.00 |
| D0603 |
|
93 |
91 |
$0.00 |
| D1330 |
|
236 |
232 |
$0.00 |
| D0601 |
|
37 |
37 |
$0.00 |