| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,922 |
7,861 |
$301K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,942 |
2,013 |
$217K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,150 |
1,356 |
$216K |
| D0210 |
Intraoral - complete series of radiographic images |
3,647 |
3,617 |
$210K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
331 |
308 |
$179K |
| D0274 |
Bitewings - four radiographic images |
5,240 |
5,223 |
$171K |
| D1120 |
Prophylaxis - child |
3,742 |
3,724 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
6,139 |
6,092 |
$140K |
| D0140 |
Limited oral evaluation - problem focused |
4,476 |
4,411 |
$122K |
| D1206 |
Topical application of fluoride varnish |
4,460 |
4,438 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,862 |
2,464 |
$110K |
| D0220 |
Intraoral - periapical first radiographic image |
5,081 |
4,957 |
$56K |
| D2954 |
|
429 |
373 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
872 |
601 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
846 |
357 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,131 |
2,204 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
353 |
288 |
$32K |
| D2791 |
|
55 |
51 |
$19K |
| D7250 |
|
110 |
71 |
$16K |
| D0272 |
Bitewings - two radiographic images |
379 |
379 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
13 |
$6K |
| D1351 |
Sealant - per tooth |
129 |
39 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
28 |
18 |
$1K |
| D2332 |
|
13 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
62 |
61 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$582.90 |