| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,510 |
2,495 |
$208K |
| D0120 |
Periodic oral evaluation - established patient |
2,381 |
2,362 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,125 |
2,123 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,352 |
1,189 |
$128K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
801 |
588 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,748 |
4,311 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
5,644 |
5,575 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,453 |
3,431 |
$45K |
| D9110 |
|
697 |
691 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
550 |
362 |
$31K |
| D1120 |
Prophylaxis - child |
791 |
785 |
$28K |
| D7230 |
|
113 |
75 |
$21K |
| D0350 |
|
1,872 |
1,012 |
$16K |
| D2920 |
|
263 |
240 |
$11K |
| D1351 |
Sealant - per tooth |
314 |
125 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
23 |
14 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
69 |
48 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
63 |
39 |
$4K |
| D2330 |
|
52 |
26 |
$4K |
| D2140 |
|
32 |
14 |
$2K |
| D1310 |
|
91 |
91 |
$0.00 |