| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,961 |
7,031 |
$345K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,380 |
1,779 |
$295K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,575 |
1,292 |
$281K |
| D0120 |
Periodic oral evaluation - established patient |
10,738 |
9,770 |
$275K |
| D0210 |
Intraoral - complete series of radiographic images |
5,871 |
4,784 |
$260K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,377 |
4,596 |
$224K |
| D1120 |
Prophylaxis - child |
6,142 |
6,014 |
$217K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,395 |
701 |
$132K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,003 |
5,886 |
$122K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,564 |
924 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
4,967 |
4,236 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,324 |
2,245 |
$48K |
| D2394 |
|
357 |
253 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,483 |
2,969 |
$36K |
| D1351 |
Sealant - per tooth |
920 |
248 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,023 |
991 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,362 |
1,095 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
274 |
207 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
371 |
366 |
$16K |
| D2160 |
|
102 |
46 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
76 |
55 |
$6K |
| D2161 |
|
23 |
15 |
$3K |
| D2332 |
|
22 |
12 |
$3K |
| D1999 |
|
2,332 |
1,755 |
$0.00 |