| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,212 |
4,200 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,802 |
1,190 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
4,305 |
4,293 |
$81K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,025 |
801 |
$64K |
| D1351 |
Sealant - per tooth |
2,546 |
630 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,837 |
1,830 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
734 |
396 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
907 |
637 |
$44K |
| D1120 |
Prophylaxis - child |
1,397 |
1,397 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,827 |
1,827 |
$33K |
| D0330 |
Panoramic radiographic image |
853 |
852 |
$30K |
| D2331 |
|
468 |
328 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,174 |
1,173 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,195 |
1,192 |
$18K |
| D2332 |
|
251 |
179 |
$16K |
| D2335 |
|
206 |
138 |
$13K |
| D2394 |
|
164 |
132 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,045 |
1,035 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
286 |
285 |
$5K |
| D9110 |
|
99 |
97 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
289 |
284 |
$3K |
| D2330 |
|
51 |
38 |
$2K |
| D1330 |
|
16,044 |
15,911 |
$11.08 |
| D9994 |
|
2,972 |
2,962 |
$0.00 |
| D1310 |
|
16,044 |
15,912 |
$0.00 |
| D9992 |
|
8,153 |
8,132 |
$0.00 |
| D9991 |
|
4,589 |
4,588 |
$0.00 |
| D9993 |
|
1,183 |
1,140 |
$0.00 |