| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,066 |
6,046 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
5,550 |
5,540 |
$117K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,432 |
853 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,846 |
5,857 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
1,883 |
1,864 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
7,571 |
7,400 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
2,722 |
2,643 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,159 |
2,150 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,542 |
2,536 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,401 |
462 |
$57K |
| D1120 |
Prophylaxis - child |
820 |
819 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
227 |
174 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
884 |
884 |
$22K |
| D2950 |
|
115 |
82 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
21 |
13 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
131 |
97 |
$10K |
| D1351 |
Sealant - per tooth |
240 |
26 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
121 |
99 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
56 |
$5K |
| D2331 |
|
50 |
39 |
$4K |
| D2394 |
|
60 |
40 |
$3K |
| D2332 |
|
40 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
62 |
62 |
$1K |
| D2140 |
|
18 |
15 |
$1K |