| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,415 |
4,189 |
$187K |
| D0330 |
Panoramic radiographic image |
4,394 |
4,178 |
$182K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,441 |
6,160 |
$172K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,565 |
1,808 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,293 |
2,097 |
$138K |
| D1120 |
Prophylaxis - child |
2,369 |
2,297 |
$106K |
| D1351 |
Sealant - per tooth |
4,261 |
1,110 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,561 |
1,152 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
1,987 |
1,895 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,390 |
2,286 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
378 |
318 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,336 |
2,233 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
287 |
252 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,110 |
1,084 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
139 |
121 |
$7K |
| D2335 |
|
47 |
40 |
$4K |
| D2332 |
|
39 |
28 |
$2K |
| D2140 |
|
34 |
29 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
22 |
22 |
$386.10 |