| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,584 |
3,487 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
5,387 |
5,271 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,721 |
1,014 |
$93K |
| D1120 |
Prophylaxis - child |
2,795 |
2,749 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,502 |
2,438 |
$53K |
| D1206 |
Topical application of fluoride varnish |
3,130 |
3,104 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
799 |
498 |
$40K |
| D0330 |
Panoramic radiographic image |
687 |
666 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
777 |
762 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
891 |
860 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
280 |
199 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,043 |
1,033 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,744 |
1,679 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
645 |
617 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
160 |
97 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
45 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
863 |
441 |
$6K |
| D2140 |
|
99 |
67 |
$4K |
| D9944 |
|
12 |
12 |
$2K |
| D2332 |
|
41 |
24 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
77 |
68 |
$2K |
| D2335 |
|
28 |
12 |
$2K |
| D0350 |
|
75 |
75 |
$2K |
| D1351 |
Sealant - per tooth |
49 |
13 |
$1K |
| D2394 |
|
14 |
12 |
$1K |
| D2160 |
|
16 |
13 |
$1K |
| D1999 |
|
15 |
12 |
$0.00 |