| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,212 |
4,180 |
$217K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,486 |
1,144 |
$152K |
| D0120 |
Periodic oral evaluation - established patient |
4,609 |
4,572 |
$99K |
| D2750 |
|
157 |
132 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,159 |
801 |
$77K |
| D1120 |
Prophylaxis - child |
1,461 |
1,451 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
852 |
852 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,052 |
1,051 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
447 |
306 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,350 |
1,330 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,684 |
1,668 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,033 |
2,964 |
$24K |
| D2394 |
|
196 |
160 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,582 |
1,568 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,103 |
2,233 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
187 |
100 |
$15K |
| D2335 |
|
127 |
94 |
$14K |
| D2332 |
|
105 |
84 |
$10K |
| D2160 |
|
101 |
85 |
$8K |
| D2161 |
|
34 |
25 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
56 |
39 |
$3K |
| D9110 |
|
12 |
12 |
$504.00 |