| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,906 |
4,807 |
$254K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,603 |
876 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
4,852 |
4,725 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,463 |
2,391 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,436 |
1,405 |
$98K |
| D0274 |
Bitewings - four radiographic images |
2,278 |
2,210 |
$81K |
| D1120 |
Prophylaxis - child |
1,426 |
1,381 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,337 |
2,256 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
596 |
367 |
$48K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
575 |
343 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
804 |
783 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,698 |
1,650 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
360 |
201 |
$24K |
| D5212 |
|
45 |
44 |
$23K |
| D2160 |
|
255 |
172 |
$23K |
| D5211 |
|
39 |
39 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
97 |
77 |
$13K |
| D0272 |
Bitewings - two radiographic images |
302 |
299 |
$9K |
| D2140 |
|
132 |
85 |
$8K |
| D1351 |
Sealant - per tooth |
201 |
54 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
557 |
505 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
26 |
$3K |