| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,411 |
4,378 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
7,279 |
7,232 |
$188K |
| D0330 |
Panoramic radiographic image |
1,059 |
1,053 |
$73K |
| D1351 |
Sealant - per tooth |
4,176 |
884 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
679 |
553 |
$35K |
| D1120 |
Prophylaxis - child |
3,481 |
3,462 |
$26K |
| D9920 |
|
688 |
659 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
653 |
561 |
$23K |
| D1330 |
|
7,871 |
7,820 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
495 |
494 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
157 |
153 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,810 |
7,758 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,815 |
2,206 |
$6K |
| D0274 |
Bitewings - four radiographic images |
4,624 |
4,597 |
$6K |
| D0272 |
Bitewings - two radiographic images |
2,539 |
2,521 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
3,183 |
3,144 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
90 |
77 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
130 |
127 |
$1K |
| D2940 |
|
13 |
12 |
$176.20 |
| D9986 |
|
15 |
13 |
$0.00 |