| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,804 |
8,801 |
$356K |
| D0120 |
Periodic oral evaluation - established patient |
9,880 |
9,875 |
$200K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,822 |
2,281 |
$190K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,714 |
1,975 |
$131K |
| D0210 |
Intraoral - complete series of radiographic images |
2,723 |
2,721 |
$102K |
| D1120 |
Prophylaxis - child |
3,111 |
3,110 |
$91K |
| D0274 |
Bitewings - four radiographic images |
4,299 |
4,297 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
4,733 |
4,715 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,203 |
2,202 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,615 |
4,605 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,325 |
3,325 |
$34K |
| D4341 |
|
634 |
261 |
$31K |
| D2750 |
|
52 |
43 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
262 |
239 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
213 |
170 |
$11K |
| D9110 |
|
553 |
549 |
$11K |
| D2952 |
|
69 |
68 |
$8K |
| D2330 |
|
53 |
40 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
224 |
220 |
$2K |
| D2331 |
|
19 |
17 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
27 |
$2K |
| D4910 |
|
24 |
24 |
$985.52 |
| D9995 |
|
15 |
15 |
$328.72 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$147.72 |