| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,757 |
5,691 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
5,397 |
5,346 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,841 |
998 |
$67K |
| D1120 |
Prophylaxis - child |
3,014 |
3,005 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,172 |
4,140 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
2,390 |
2,381 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
2,444 |
2,333 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,158 |
842 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,979 |
2,969 |
$27K |
| D0274 |
Bitewings - four radiographic images |
3,212 |
3,166 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
833 |
552 |
$21K |
| D2750 |
|
105 |
83 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
5,742 |
5,617 |
$14K |
| D1351 |
Sealant - per tooth |
533 |
54 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,687 |
4,531 |
$11K |
| D1206 |
Topical application of fluoride varnish |
410 |
409 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
71 |
27 |
$5K |
| D0272 |
Bitewings - two radiographic images |
842 |
841 |
$4K |
| D0330 |
Panoramic radiographic image |
456 |
444 |
$3K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
24 |
$691.00 |
| D0180 |
|
26 |
26 |
$572.00 |
| D2952 |
|
17 |
14 |
$509.00 |
| D0603 |
|
13 |
13 |
$130.00 |
| D0601 |
|
13 |
13 |
$100.00 |