| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,039 |
2,036 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,341 |
2,338 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,067 |
1,065 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,187 |
3,182 |
$58K |
| D1120 |
Prophylaxis - child |
1,707 |
1,704 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,581 |
1,559 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,011 |
1,010 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
647 |
625 |
$19K |
| D9110 |
|
246 |
232 |
$14K |
| D2394 |
|
64 |
51 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
39 |
$6K |
| D2931 |
|
42 |
26 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
423 |
413 |
$5K |
| D2160 |
|
40 |
24 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
25 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
25 |
$3K |
| D0330 |
Panoramic radiographic image |
46 |
46 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
15 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
14 |
$1K |
| D1351 |
Sealant - per tooth |
56 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
54 |
54 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
16 |
$129.03 |