| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
13,460 |
13,375 |
$397K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,620 |
1,443 |
$293K |
| D1110 |
Prophylaxis - adult |
5,866 |
5,808 |
$269K |
| D1120 |
Prophylaxis - child |
8,424 |
8,353 |
$267K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,644 |
14,513 |
$265K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,096 |
6,995 |
$244K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,364 |
1,745 |
$244K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,573 |
1,614 |
$238K |
| D0220 |
Intraoral - periapical first radiographic image |
17,810 |
17,561 |
$202K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,163 |
16,012 |
$190K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,556 |
1,465 |
$189K |
| D0210 |
Intraoral - complete series of radiographic images |
3,064 |
2,805 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
7,434 |
7,395 |
$145K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,538 |
1,381 |
$141K |
| D1351 |
Sealant - per tooth |
4,552 |
1,158 |
$108K |
| D2140 |
|
1,896 |
990 |
$104K |
| D4341 |
|
645 |
237 |
$77K |
| D9410 |
|
639 |
418 |
$59K |
| D2160 |
|
669 |
457 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,054 |
1,033 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
254 |
195 |
$23K |
| D2335 |
|
135 |
81 |
$16K |
| D2332 |
|
146 |
79 |
$15K |
| D5213 |
|
12 |
12 |
$10K |
| D5214 |
|
12 |
12 |
$10K |
| D2161 |
|
45 |
29 |
$4K |
| D0272 |
Bitewings - two radiographic images |
204 |
204 |
$4K |
| D2331 |
|
42 |
28 |
$4K |
| D2330 |
|
31 |
18 |
$2K |
| D0270 |
|
28 |
28 |
$288.81 |
| D1999 |
|
51 |
41 |
$0.00 |