| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,462 |
1,388 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
863 |
566 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,091 |
479 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
942 |
876 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,103 |
1,046 |
$22K |
| D0274 |
Bitewings - four radiographic images |
901 |
855 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
783 |
731 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
323 |
201 |
$19K |
| D0330 |
Panoramic radiographic image |
393 |
382 |
$13K |
| D1120 |
Prophylaxis - child |
252 |
237 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,263 |
1,186 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
226 |
147 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
100 |
68 |
$5K |
| D1206 |
Topical application of fluoride varnish |
329 |
304 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
35 |
34 |
$2K |
| D2140 |
|
25 |
17 |
$1K |
| D2330 |
|
20 |
14 |
$890.80 |
| D2335 |
|
13 |
12 |
$888.00 |
| D2331 |
|
19 |
13 |
$721.90 |
| D0230 |
Intraoral - periapical each additional radiographic image |
93 |
57 |
$414.81 |
| D0270 |
|
13 |
13 |
$77.49 |