| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,747 |
4,484 |
$178K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,715 |
1,429 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
5,908 |
5,544 |
$113K |
| D0274 |
Bitewings - four radiographic images |
2,800 |
2,649 |
$63K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
970 |
702 |
$59K |
| D0330 |
Panoramic radiographic image |
1,258 |
1,178 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,153 |
2,878 |
$53K |
| D1120 |
Prophylaxis - child |
2,169 |
1,959 |
$52K |
| D2140 |
|
640 |
441 |
$33K |
| D2335 |
|
295 |
224 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,675 |
3,248 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
998 |
922 |
$26K |
| D2331 |
|
230 |
177 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,104 |
969 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
176 |
$12K |
| D2160 |
|
146 |
122 |
$10K |
| D2330 |
|
44 |
26 |
$2K |
| D2332 |
|
34 |
26 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
51 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
203 |
153 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$844.80 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$448.68 |
| D1999 |
|
963 |
784 |
$0.00 |