| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,338 |
4,310 |
$203K |
| D0330 |
Panoramic radiographic image |
2,223 |
2,212 |
$163K |
| D0274 |
Bitewings - four radiographic images |
4,195 |
4,176 |
$142K |
| D1206 |
Topical application of fluoride varnish |
5,643 |
5,616 |
$138K |
| D2721 |
|
118 |
83 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,218 |
3,202 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
3,903 |
3,888 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
6,155 |
5,808 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
708 |
412 |
$69K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
821 |
420 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,334 |
4,524 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,954 |
1,879 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
781 |
405 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
827 |
402 |
$56K |
| D4341 |
|
278 |
101 |
$54K |
| D1120 |
Prophylaxis - child |
1,507 |
1,504 |
$50K |
| D1351 |
Sealant - per tooth |
1,105 |
245 |
$45K |
| D1330 |
|
919 |
916 |
$29K |
| D2140 |
|
368 |
175 |
$27K |
| D4910 |
|
333 |
331 |
$26K |
| D2950 |
|
134 |
94 |
$25K |
| D0272 |
Bitewings - two radiographic images |
264 |
264 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
12 |
$4K |
| D2160 |
|
34 |
27 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D1999 |
|
4,217 |
3,492 |
$0.00 |