| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,215 |
3,010 |
$158K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,337 |
642 |
$114K |
| D0274 |
Bitewings - four radiographic images |
3,417 |
3,180 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,855 |
3,538 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,487 |
625 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,846 |
3,200 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,219 |
1,102 |
$63K |
| D4910 |
|
1,396 |
1,351 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,756 |
3,520 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,553 |
3,267 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,205 |
1,077 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
364 |
133 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
100 |
42 |
$9K |
| D0502 |
|
601 |
588 |
$4K |
| D4341 |
|
80 |
24 |
$4K |
| D1330 |
|
476 |
461 |
$3K |
| D0330 |
Panoramic radiographic image |
84 |
78 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
31 |
14 |
$2K |
| D1120 |
Prophylaxis - child |
28 |
27 |
$856.31 |
| D0603 |
|
4,839 |
4,597 |
$27.04 |
| D0602 |
|
217 |
211 |
$0.00 |
| D0601 |
|
13 |
12 |
$0.00 |
| D9222 |
|
12 |
12 |
$0.00 |