| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,754 |
7,475 |
$264K |
| D0120 |
Periodic oral evaluation - established patient |
7,917 |
7,691 |
$137K |
| D0210 |
Intraoral - complete series of radiographic images |
2,247 |
2,128 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,082 |
1,335 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,691 |
1,001 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,594 |
624 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,565 |
2,462 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
2,224 |
2,099 |
$48K |
| D1120 |
Prophylaxis - child |
2,326 |
2,269 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,750 |
1,676 |
$47K |
| D0330 |
Panoramic radiographic image |
1,085 |
1,020 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,794 |
2,725 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
472 |
365 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,690 |
1,635 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
130 |
98 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,382 |
1,290 |
$7K |
| D2335 |
|
57 |
28 |
$5K |
| D1351 |
Sealant - per tooth |
201 |
47 |
$4K |
| D2140 |
|
59 |
44 |
$2K |
| D2330 |
|
47 |
24 |
$2K |
| D2931 |
|
18 |
16 |
$2K |
| D2394 |
|
13 |
12 |
$989.02 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
13 |
$70.00 |