| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,995 |
3,843 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,458 |
5,254 |
$139K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,224 |
305 |
$131K |
| D0274 |
Bitewings - four radiographic images |
4,321 |
4,165 |
$99K |
| D0330 |
Panoramic radiographic image |
2,252 |
2,158 |
$90K |
| D1120 |
Prophylaxis - child |
1,253 |
1,197 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
7,085 |
6,603 |
$51K |
| D9110 |
|
2,146 |
1,933 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
756 |
409 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,119 |
5,089 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,607 |
2,503 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,735 |
1,677 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
751 |
381 |
$32K |
| D2394 |
|
249 |
172 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
551 |
525 |
$16K |
| D5110 |
|
29 |
26 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
242 |
147 |
$14K |
| D2335 |
|
53 |
26 |
$4K |
| D1351 |
Sealant - per tooth |
48 |
12 |
$844.48 |
| D0272 |
Bitewings - two radiographic images |
41 |
26 |
$382.71 |
| D9987 |
|
100 |
92 |
$279.00 |