| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,533 |
3,412 |
$138K |
| D2140 |
|
2,200 |
1,240 |
$113K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,602 |
1,000 |
$100K |
| D0330 |
Panoramic radiographic image |
3,313 |
1,987 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,159 |
728 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,393 |
2,290 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,560 |
285 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,926 |
2,865 |
$55K |
| D2331 |
|
612 |
372 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
2,550 |
2,003 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
1,134 |
1,100 |
$40K |
| D5110 |
|
71 |
71 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
2,086 |
2,044 |
$34K |
| D2330 |
|
475 |
286 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,264 |
1,248 |
$26K |
| D2160 |
|
217 |
165 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
185 |
134 |
$17K |
| D1120 |
Prophylaxis - child |
337 |
337 |
$11K |
| D1351 |
Sealant - per tooth |
351 |
103 |
$11K |
| D5212 |
|
12 |
12 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
131 |
131 |
$3K |
| D2332 |
|
19 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
121 |
118 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
260 |
208 |
$2K |
| D5120 |
|
12 |
12 |
$0.00 |