| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,533 |
6,402 |
$207K |
| D2750 |
|
296 |
207 |
$179K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,245 |
595 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,498 |
800 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
6,365 |
6,273 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
2,127 |
2,083 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,401 |
3,336 |
$61K |
| D1120 |
Prophylaxis - child |
3,014 |
2,992 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
727 |
243 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,422 |
6,028 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
8,441 |
7,181 |
$29K |
| D2950 |
|
226 |
162 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
694 |
384 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,440 |
3,416 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,282 |
1,247 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
724 |
697 |
$10K |
| D2332 |
|
131 |
48 |
$9K |
| D0180 |
|
437 |
395 |
$9K |
| D1351 |
Sealant - per tooth |
1,277 |
207 |
$7K |
| D1206 |
Topical application of fluoride varnish |
882 |
878 |
$5K |
| D2394 |
|
37 |
25 |
$4K |
| D0272 |
Bitewings - two radiographic images |
1,162 |
1,162 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
39 |
$2K |
| D0270 |
|
268 |
248 |
$2K |
| D0601 |
|
155 |
155 |
$860.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$215.00 |
| D0350 |
|
281 |
262 |
$197.00 |
| D1999 |
|
258 |
228 |
$0.00 |
| D1330 |
|
147 |
132 |
$0.00 |
| D9997 |
|
116 |
109 |
$0.00 |