| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,632 |
3,457 |
$118K |
| D0274 |
Bitewings - four radiographic images |
3,841 |
3,613 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,071 |
2,691 |
$114K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,804 |
5,467 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,400 |
795 |
$101K |
| D0140 |
Limited oral evaluation - problem focused |
3,625 |
3,392 |
$97K |
| D1120 |
Prophylaxis - child |
2,335 |
2,176 |
$96K |
| D0330 |
Panoramic radiographic image |
1,588 |
1,450 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
3,384 |
3,177 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,068 |
559 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
674 |
469 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,276 |
4,049 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
966 |
944 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
813 |
414 |
$44K |
| D1351 |
Sealant - per tooth |
649 |
147 |
$24K |
| D2331 |
|
329 |
213 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,883 |
1,497 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
37 |
27 |
$16K |
| D7250 |
|
56 |
29 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
106 |
76 |
$6K |
| D2330 |
|
98 |
44 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
41 |
$4K |
| D2140 |
|
56 |
38 |
$3K |
| D2950 |
|
14 |
13 |
$1K |
| D2332 |
|
13 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
31 |
31 |
$926.08 |
| D1320 |
|
64 |
47 |
$83.72 |