| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,851 |
9,481 |
$455K |
| D0120 |
Periodic oral evaluation - established patient |
13,741 |
13,415 |
$377K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,484 |
1,155 |
$252K |
| D1120 |
Prophylaxis - child |
6,616 |
6,577 |
$236K |
| D0272 |
Bitewings - two radiographic images |
6,640 |
6,569 |
$145K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,423 |
842 |
$144K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,137 |
7,070 |
$143K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,504 |
2,357 |
$109K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
868 |
538 |
$106K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,093 |
534 |
$91K |
| D0274 |
Bitewings - four radiographic images |
2,928 |
2,679 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
876 |
452 |
$66K |
| D1206 |
Topical application of fluoride varnish |
1,937 |
1,929 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,574 |
1,480 |
$39K |
| D0330 |
Panoramic radiographic image |
816 |
740 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,274 |
3,010 |
$37K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
210 |
81 |
$32K |
| D1351 |
Sealant - per tooth |
1,046 |
264 |
$31K |
| D2140 |
|
481 |
267 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
540 |
295 |
$28K |
| D9248 |
|
158 |
150 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
407 |
407 |
$18K |
| D9920 |
|
182 |
167 |
$11K |
| D2931 |
|
43 |
30 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
826 |
525 |
$5K |
| D2160 |
|
33 |
26 |
$3K |
| D2332 |
|
22 |
14 |
$3K |