| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,938 |
5,790 |
$187K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,543 |
1,295 |
$176K |
| D0274 |
Bitewings - four radiographic images |
3,969 |
3,878 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,915 |
4,828 |
$86K |
| D0330 |
Panoramic radiographic image |
2,053 |
1,968 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,260 |
2,211 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
3,324 |
3,238 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,695 |
3,437 |
$36K |
| D2335 |
|
439 |
294 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
2,420 |
2,181 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
237 |
115 |
$17K |
| D2332 |
|
281 |
199 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
361 |
352 |
$14K |
| D2331 |
|
244 |
170 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
366 |
238 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
934 |
864 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
193 |
143 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
185 |
144 |
$7K |
| D2140 |
|
182 |
106 |
$5K |
| D2950 |
|
50 |
35 |
$5K |
| D2330 |
|
116 |
63 |
$4K |
| D9110 |
|
105 |
85 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
55 |
$3K |