| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,189 |
4,968 |
$174K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,235 |
575 |
$125K |
| D0210 |
Intraoral - complete series of radiographic images |
2,238 |
2,124 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
4,421 |
4,285 |
$101K |
| D0274 |
Bitewings - four radiographic images |
3,230 |
3,124 |
$98K |
| D1120 |
Prophylaxis - child |
2,012 |
1,988 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,470 |
1,963 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,017 |
1,997 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
555 |
267 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,227 |
1,173 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
413 |
292 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
211 |
140 |
$21K |
| D2950 |
|
245 |
186 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,234 |
1,161 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$10K |
| D2394 |
|
41 |
24 |
$6K |
| D2160 |
|
65 |
44 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
69 |
51 |
$4K |
| D2791 |
|
18 |
12 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
15 |
$2K |
| D7970 |
|
13 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
12 |
$772.56 |