| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,321 |
6,153 |
$206K |
| D0210 |
Intraoral - complete series of radiographic images |
2,629 |
2,440 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,611 |
4,402 |
$119K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,158 |
1,418 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
5,677 |
5,520 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,622 |
754 |
$88K |
| D0330 |
Panoramic radiographic image |
2,121 |
1,978 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,670 |
1,078 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
2,958 |
2,772 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
838 |
605 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,879 |
2,704 |
$44K |
| D1120 |
Prophylaxis - child |
2,293 |
2,226 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,704 |
2,635 |
$39K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
95 |
92 |
$36K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
570 |
386 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
4,993 |
4,532 |
$23K |
| D2160 |
|
305 |
219 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,062 |
1,026 |
$15K |
| D2140 |
|
333 |
215 |
$13K |
| D3320 |
|
43 |
40 |
$13K |
| D2330 |
|
205 |
112 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,576 |
1,542 |
$9K |
| D2331 |
|
149 |
95 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
136 |
67 |
$8K |
| D1351 |
Sealant - per tooth |
306 |
75 |
$6K |
| D0272 |
Bitewings - two radiographic images |
640 |
608 |
$5K |
| D2332 |
|
63 |
40 |
$5K |
| D4341 |
|
44 |
14 |
$4K |
| D2335 |
|
37 |
26 |
$3K |
| D4342 |
|
47 |
15 |
$3K |
| D2394 |
|
22 |
16 |
$2K |
| D9239 |
|
36 |
19 |
$1K |
| D0270 |
|
211 |
206 |
$1K |
| D9243 |
|
36 |
19 |
$880.00 |
| D9610 |
|
36 |
19 |
$478.42 |
| D4910 |
|
12 |
12 |
$409.56 |
| D1999 |
|
852 |
679 |
$0.00 |
| D9219 |
|
35 |
18 |
$0.00 |