| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,994 |
1,974 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,007 |
466 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,210 |
2,179 |
$44K |
| D5110 |
|
74 |
74 |
$38K |
| D0274 |
Bitewings - four radiographic images |
999 |
982 |
$32K |
| D2332 |
|
472 |
347 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
381 |
223 |
$21K |
| D0330 |
Panoramic radiographic image |
546 |
536 |
$16K |
| D2330 |
|
320 |
137 |
$14K |
| D5120 |
|
26 |
26 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
295 |
163 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
205 |
159 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
276 |
274 |
$12K |
| D2331 |
|
169 |
114 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
859 |
809 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
415 |
375 |
$6K |
| D5650 |
|
111 |
63 |
$5K |
| D2160 |
|
45 |
41 |
$3K |
| D2140 |
|
18 |
15 |
$1K |
| D5422 |
|
72 |
66 |
$1K |
| D5410 |
|
73 |
60 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
62 |
60 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
15 |
$1K |
| D5411 |
|
28 |
25 |
$523.60 |
| D5421 |
|
12 |
12 |
$224.40 |