| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,424 |
4,166 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,791 |
3,121 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,630 |
898 |
$118K |
| D1120 |
Prophylaxis - child |
2,221 |
2,131 |
$94K |
| D0274 |
Bitewings - four radiographic images |
2,981 |
2,824 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
3,636 |
3,469 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,422 |
3,258 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,383 |
1,281 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
5,797 |
4,591 |
$70K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
348 |
155 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
641 |
356 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,235 |
1,162 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,426 |
2,230 |
$28K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
40 |
27 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
291 |
112 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
89 |
$11K |
| D0272 |
Bitewings - two radiographic images |
90 |
85 |
$2K |