| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,072 |
2,019 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,111 |
3,039 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
980 |
611 |
$56K |
| D0330 |
Panoramic radiographic image |
1,753 |
1,699 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
844 |
546 |
$53K |
| D1120 |
Prophylaxis - child |
996 |
978 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,754 |
1,714 |
$39K |
| D2394 |
|
486 |
279 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,277 |
1,249 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
359 |
323 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
610 |
571 |
$14K |
| D2335 |
|
150 |
70 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
151 |
80 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,470 |
1,401 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
210 |
132 |
$9K |
| D1351 |
Sealant - per tooth |
118 |
41 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
36 |
$3K |
| D0272 |
Bitewings - two radiographic images |
136 |
136 |
$2K |
| D1206 |
Topical application of fluoride varnish |
113 |
113 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
349 |
239 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
49 |
46 |
$1K |