| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,859 |
3,403 |
$172K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,421 |
648 |
$103K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,066 |
666 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
3,160 |
2,851 |
$81K |
| D0272 |
Bitewings - two radiographic images |
2,582 |
2,303 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,049 |
918 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
611 |
396 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,032 |
1,748 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
160 |
113 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
244 |
230 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,835 |
1,075 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
505 |
502 |
$10K |
| D1120 |
Prophylaxis - child |
194 |
194 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
64 |
$6K |
| D2332 |
|
23 |
13 |
$2K |
| D2331 |
|
14 |
12 |
$1K |