| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,145 |
6,795 |
$239K |
| D0120 |
Periodic oral evaluation - established patient |
8,792 |
8,375 |
$150K |
| D0210 |
Intraoral - complete series of radiographic images |
2,471 |
2,341 |
$143K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,836 |
1,636 |
$140K |
| D0274 |
Bitewings - four radiographic images |
4,501 |
4,302 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,641 |
795 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,392 |
1,092 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,287 |
4,089 |
$66K |
| D1120 |
Prophylaxis - child |
3,177 |
3,033 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
2,282 |
2,023 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,711 |
1,616 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,890 |
1,794 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
343 |
235 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
147 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,092 |
1,014 |
$5K |
| D2140 |
|
92 |
61 |
$4K |
| D2330 |
|
42 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
14 |
$864.00 |