| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,547 |
4,493 |
$83K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,439 |
690 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
3,532 |
3,469 |
$45K |
| D4341 |
|
1,232 |
541 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,394 |
4,322 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
2,223 |
2,096 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,542 |
2,508 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
812 |
495 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
1,040 |
1,027 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
776 |
515 |
$19K |
| D0330 |
Panoramic radiographic image |
1,129 |
1,104 |
$18K |
| D0274 |
Bitewings - four radiographic images |
2,490 |
2,450 |
$16K |
| D1120 |
Prophylaxis - child |
1,019 |
992 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
727 |
429 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
5,325 |
4,930 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,099 |
3,761 |
$14K |
| D2332 |
|
369 |
194 |
$13K |
| D4346 |
|
552 |
538 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
237 |
145 |
$7K |
| D2750 |
|
18 |
16 |
$4K |
| D1206 |
Topical application of fluoride varnish |
150 |
145 |
$2K |
| D2335 |
|
54 |
28 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
157 |
85 |
$2K |
| D2140 |
|
70 |
50 |
$2K |
| D9920 |
|
100 |
87 |
$1K |
| D4910 |
|
25 |
25 |
$821.00 |
| D9430 |
|
63 |
62 |
$375.00 |
| D0601 |
|
13 |
13 |
$90.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
17 |
14 |
$0.00 |
| D1330 |
|
36 |
28 |
$0.00 |