| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,812 |
5,811 |
$502K |
| D0120 |
Periodic oral evaluation - established patient |
6,540 |
6,539 |
$282K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,577 |
1,471 |
$267K |
| D0274 |
Bitewings - four radiographic images |
2,686 |
2,686 |
$116K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
484 |
448 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
965 |
960 |
$74K |
| D1120 |
Prophylaxis - child |
1,137 |
1,137 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,186 |
3,186 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
511 |
491 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
1,472 |
1,452 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
475 |
475 |
$14K |
| D2335 |
|
28 |
27 |
$11K |
| D2394 |
|
36 |
34 |
$9K |
| D2332 |
|
32 |
29 |
$7K |
| D0330 |
Panoramic radiographic image |
97 |
97 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
263 |
258 |
$5K |
| D1351 |
Sealant - per tooth |
27 |
26 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
77 |
77 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
71 |
70 |
$1K |
| D1320 |
|
72 |
72 |
$568.00 |
| D1999 |
|
2,014 |
1,835 |
$0.00 |