| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,625 |
6,620 |
$372K |
| D0210 |
Intraoral - complete series of radiographic images |
1,828 |
1,825 |
$131K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,603 |
632 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
3,282 |
3,278 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,116 |
657 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,559 |
2,556 |
$74K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
752 |
402 |
$65K |
| D0330 |
Panoramic radiographic image |
1,432 |
1,432 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,220 |
1,219 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,011 |
2,008 |
$39K |
| D5110 |
|
65 |
64 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
328 |
251 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
508 |
321 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,598 |
1,575 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
977 |
976 |
$14K |
| D2331 |
|
162 |
108 |
$13K |
| D5120 |
|
12 |
12 |
$7K |
| D9944 |
|
38 |
38 |
$5K |
| D2332 |
|
33 |
24 |
$3K |
| D1320 |
|
273 |
273 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
74 |
74 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
68 |
67 |
$808.75 |
| D2330 |
|
18 |
13 |
$755.36 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$507.30 |
| D0190 |
|
182 |
150 |
$0.00 |
| D1999 |
|
339 |
291 |
$0.00 |