| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,024 |
3,021 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
3,742 |
3,738 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,690 |
2,688 |
$76K |
| D2750 |
|
100 |
85 |
$59K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
676 |
522 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
808 |
411 |
$58K |
| D1120 |
Prophylaxis - child |
1,422 |
1,421 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
627 |
517 |
$55K |
| D2332 |
|
277 |
200 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,107 |
2,104 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,727 |
1,698 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,946 |
1,906 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
578 |
577 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
366 |
360 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
151 |
$11K |
| D0330 |
Panoramic radiographic image |
314 |
313 |
$11K |
| D0272 |
Bitewings - two radiographic images |
424 |
423 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
60 |
52 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
27 |
$3K |
| D2954 |
|
16 |
14 |
$2K |
| D1351 |
Sealant - per tooth |
15 |
13 |
$2K |
| D2140 |
|
13 |
12 |
$858.80 |
| D9110 |
|
27 |
27 |
$744.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
33 |
$281.18 |