| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,967 |
3,772 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,128 |
2,981 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,593 |
858 |
$85K |
| D0274 |
Bitewings - four radiographic images |
4,608 |
4,411 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,619 |
829 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
4,314 |
4,131 |
$73K |
| D0330 |
Panoramic radiographic image |
1,366 |
1,294 |
$62K |
| D1351 |
Sealant - per tooth |
2,412 |
724 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,205 |
3,090 |
$48K |
| D1120 |
Prophylaxis - child |
2,332 |
2,246 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,445 |
1,844 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
654 |
554 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
789 |
732 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,842 |
2,689 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,283 |
1,229 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
150 |
26 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
114 |
84 |
$7K |
| D5120 |
|
13 |
12 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
81 |
42 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
67 |
40 |
$4K |
| D2330 |
|
45 |
28 |
$2K |
| D2140 |
|
51 |
32 |
$2K |
| D9243 |
|
38 |
16 |
$1K |
| D9239 |
|
16 |
16 |
$1K |
| D2331 |
|
16 |
13 |
$1K |