| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,584 |
3,166 |
$156K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,725 |
908 |
$111K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,205 |
674 |
$97K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
768 |
348 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
2,322 |
1,604 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,470 |
2,109 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
3,771 |
3,296 |
$78K |
| D0274 |
Bitewings - four radiographic images |
2,344 |
2,014 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,793 |
1,526 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,195 |
3,479 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,651 |
2,170 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
571 |
218 |
$38K |
| D0330 |
Panoramic radiographic image |
895 |
748 |
$34K |
| D4346 |
|
199 |
161 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,367 |
1,180 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
147 |
$11K |
| D4910 |
|
103 |
78 |
$9K |
| D2332 |
|
67 |
38 |
$6K |
| D2394 |
|
61 |
29 |
$5K |
| D1120 |
Prophylaxis - child |
105 |
95 |
$3K |
| D1351 |
Sealant - per tooth |
93 |
12 |
$352.20 |
| D1206 |
Topical application of fluoride varnish |
57 |
42 |
$267.00 |