| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
683 |
620 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
453 |
317 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
911 |
809 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
385 |
275 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
470 |
244 |
$21K |
| D1110 |
Prophylaxis - adult |
545 |
481 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
671 |
597 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
644 |
581 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
337 |
229 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
514 |
472 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
34 |
26 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
407 |
362 |
$6K |
| D0274 |
Bitewings - four radiographic images |
382 |
348 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,046 |
924 |
$6K |
| D9110 |
|
99 |
85 |
$5K |
| D2332 |
|
81 |
57 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
819 |
659 |
$4K |
| D1351 |
Sealant - per tooth |
95 |
39 |
$4K |
| D2335 |
|
19 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
130 |
115 |
$1K |
| D2160 |
|
17 |
15 |
$986.85 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
13 |
$914.85 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$803.60 |