| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,087 |
4,970 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
6,590 |
6,459 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,760 |
1,178 |
$90K |
| D0274 |
Bitewings - four radiographic images |
3,185 |
3,100 |
$61K |
| D1120 |
Prophylaxis - child |
2,427 |
2,375 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,212 |
3,124 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
661 |
476 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
802 |
589 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,792 |
1,701 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
546 |
291 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
980 |
941 |
$24K |
| D0330 |
Panoramic radiographic image |
573 |
544 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,358 |
1,314 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
171 |
123 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,866 |
1,785 |
$9K |
| D2160 |
|
67 |
48 |
$4K |
| D2140 |
|
92 |
77 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
130 |
105 |
$665.00 |