| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,036 |
5,281 |
$273K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,242 |
839 |
$205K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,800 |
802 |
$171K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,688 |
3,180 |
$155K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,029 |
667 |
$139K |
| D0330 |
Panoramic radiographic image |
2,523 |
2,094 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
3,418 |
3,029 |
$98K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
339 |
274 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,550 |
1,325 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
406 |
271 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,131 |
944 |
$39K |
| D2330 |
|
316 |
183 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
831 |
739 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,833 |
1,545 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
260 |
227 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,406 |
1,200 |
$12K |
| D2331 |
|
70 |
50 |
$11K |
| D4355 |
|
62 |
44 |
$5K |
| D1120 |
Prophylaxis - child |
95 |
92 |
$5K |
| D2332 |
|
13 |
12 |
$3K |
| D0180 |
|
67 |
53 |
$2K |
| D4341 |
|
25 |
12 |
$1K |
| D0601 |
|
155 |
145 |
$0.00 |
| D0602 |
|
57 |
52 |
$0.00 |