| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,039 |
4,027 |
$245K |
| D0120 |
Periodic oral evaluation - established patient |
6,451 |
6,441 |
$233K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,861 |
978 |
$175K |
| D1206 |
Topical application of fluoride varnish |
5,395 |
5,388 |
$172K |
| D0140 |
Limited oral evaluation - problem focused |
4,282 |
4,066 |
$167K |
| D0330 |
Panoramic radiographic image |
1,888 |
1,881 |
$161K |
| D0274 |
Bitewings - four radiographic images |
3,580 |
3,573 |
$151K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,946 |
4,694 |
$149K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,435 |
865 |
$131K |
| D0220 |
Intraoral - periapical first radiographic image |
5,911 |
5,794 |
$101K |
| D1120 |
Prophylaxis - child |
2,293 |
2,291 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,236 |
766 |
$91K |
| D1351 |
Sealant - per tooth |
1,904 |
493 |
$72K |
| D2331 |
|
626 |
386 |
$67K |
| D2160 |
|
428 |
308 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
351 |
129 |
$31K |
| D0272 |
Bitewings - two radiographic images |
822 |
819 |
$30K |
| D2140 |
|
322 |
223 |
$20K |
| D0240 |
|
518 |
265 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
106 |
80 |
$12K |
| D2335 |
|
58 |
40 |
$6K |
| D4355 |
|
107 |
107 |
$5K |
| D2330 |
|
59 |
42 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39 |
12 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$1K |