| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,774 |
2,672 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,199 |
4,067 |
$103K |
| D0330 |
Panoramic radiographic image |
2,770 |
2,689 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,863 |
3,733 |
$85K |
| D2335 |
|
992 |
592 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,983 |
920 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,120 |
664 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
843 |
603 |
$44K |
| D1120 |
Prophylaxis - child |
681 |
669 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
404 |
173 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,444 |
1,416 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
868 |
746 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,173 |
2,070 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
165 |
134 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,616 |
1,513 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
93 |
63 |
$4K |
| D9110 |
|
163 |
149 |
$3K |
| D2330 |
|
32 |
24 |
$1K |
| D2332 |
|
22 |
13 |
$1K |
| D2394 |
|
13 |
12 |
$1K |
| D2331 |
|
14 |
13 |
$649.55 |
| D9986 |
|
765 |
641 |
$216.00 |