| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,158 |
4,121 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
5,021 |
4,981 |
$144K |
| D1206 |
Topical application of fluoride varnish |
5,644 |
5,591 |
$141K |
| D0330 |
Panoramic radiographic image |
1,413 |
1,398 |
$109K |
| D0274 |
Bitewings - four radiographic images |
2,619 |
2,602 |
$100K |
| D4341 |
|
420 |
162 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
2,696 |
2,238 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,421 |
1,410 |
$56K |
| D1120 |
Prophylaxis - child |
1,550 |
1,542 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
529 |
315 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
623 |
329 |
$41K |
| D1330 |
|
1,576 |
1,559 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,636 |
2,489 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,407 |
1,512 |
$33K |
| D4910 |
|
267 |
264 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
67 |
$16K |
| D4355 |
|
149 |
147 |
$9K |
| D2331 |
|
34 |
27 |
$4K |
| D1351 |
Sealant - per tooth |
104 |
25 |
$4K |
| D2330 |
|
18 |
12 |
$2K |
| D1999 |
|
130 |
108 |
$0.00 |