| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,704 |
2,693 |
$216K |
| D0120 |
Periodic oral evaluation - established patient |
3,107 |
3,098 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,998 |
1,777 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,422 |
2,414 |
$151K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,190 |
6,336 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,712 |
1,161 |
$113K |
| D1120 |
Prophylaxis - child |
2,333 |
2,320 |
$82K |
| D2330 |
|
1,053 |
677 |
$81K |
| D0350 |
|
8,698 |
2,791 |
$76K |
| D0272 |
Bitewings - two radiographic images |
5,555 |
5,529 |
$65K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
556 |
392 |
$37K |
| D4341 |
|
497 |
133 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
276 |
222 |
$31K |
| D2140 |
|
443 |
292 |
$24K |
| D7510 |
|
123 |
123 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$7K |
| D1351 |
Sealant - per tooth |
229 |
53 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
122 |
121 |
$5K |
| D2335 |
|
43 |
32 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
81 |
50 |
$4K |
| D2954 |
|
17 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
52 |
$544.00 |