| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,521 |
6,508 |
$237K |
| D0120 |
Periodic oral evaluation - established patient |
6,435 |
6,417 |
$133K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,722 |
1,114 |
$129K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,604 |
8,533 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
9,384 |
9,263 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
5,368 |
5,346 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,548 |
894 |
$83K |
| D1120 |
Prophylaxis - child |
2,043 |
2,034 |
$63K |
| D2394 |
|
520 |
411 |
$62K |
| D9310 |
|
1,100 |
1,096 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,040 |
2,039 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,030 |
2,024 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,469 |
3,458 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
639 |
417 |
$22K |
| D2335 |
|
150 |
117 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
141 |
126 |
$7K |
| D1206 |
Topical application of fluoride varnish |
246 |
246 |
$6K |
| D2161 |
|
59 |
54 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
71 |
$3K |
| D4341 |
|
47 |
15 |
$2K |
| D2954 |
|
15 |
14 |
$1K |
| D9110 |
|
67 |
66 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$161.79 |