| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,207 |
3,207 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,617 |
814 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
3,732 |
3,732 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,605 |
2,605 |
$72K |
| D0330 |
Panoramic radiographic image |
1,501 |
1,501 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
1,299 |
1,288 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
285 |
194 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
531 |
238 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,257 |
2,257 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,778 |
2,756 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
530 |
530 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,981 |
1,957 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
179 |
117 |
$15K |
| D1120 |
Prophylaxis - child |
367 |
367 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
25 |
$4K |
| D2332 |
|
22 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
62 |
62 |
$1K |