| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,814 |
2,690 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,009 |
686 |
$91K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
950 |
276 |
$82K |
| D1206 |
Topical application of fluoride varnish |
3,483 |
3,200 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,945 |
2,754 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
597 |
288 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,814 |
1,720 |
$30K |
| D1120 |
Prophylaxis - child |
959 |
799 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
782 |
731 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
353 |
340 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
606 |
576 |
$13K |
| D2740 |
Crown - porcelain/ceramic |
36 |
30 |
$12K |
| D4910 |
|
227 |
224 |
$12K |
| D0330 |
Panoramic radiographic image |
727 |
670 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
123 |
77 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
484 |
450 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
47 |
27 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
160 |
157 |
$2K |
| D2331 |
|
20 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
15 |
$1K |
| D2330 |
|
21 |
16 |
$901.93 |
| D0272 |
Bitewings - two radiographic images |
30 |
24 |
$230.44 |