| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,368 |
5,366 |
$207K |
| D0120 |
Periodic oral evaluation - established patient |
9,239 |
9,232 |
$196K |
| D0274 |
Bitewings - four radiographic images |
6,671 |
6,669 |
$137K |
| D2791 |
|
490 |
439 |
$121K |
| D2160 |
|
1,429 |
1,254 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,327 |
1,054 |
$97K |
| D0210 |
Intraoral - complete series of radiographic images |
2,323 |
2,314 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
8,449 |
8,408 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,080 |
938 |
$40K |
| D9110 |
|
2,826 |
2,710 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
540 |
436 |
$31K |
| D1120 |
Prophylaxis - child |
932 |
932 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
456 |
369 |
$26K |
| D2920 |
|
650 |
572 |
$17K |
| D2752 |
|
50 |
40 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,080 |
2,072 |
$11K |
| D0272 |
Bitewings - two radiographic images |
822 |
821 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
470 |
470 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
641 |
630 |
$7K |
| D2332 |
|
64 |
49 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
111 |
$4K |
| D2954 |
|
29 |
28 |
$3K |
| D2161 |
|
25 |
25 |
$2K |
| D2394 |
|
15 |
14 |
$1K |
| D0270 |
|
85 |
85 |
$821.51 |
| D1999 |
|
52 |
50 |
$0.00 |