| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,838 |
1,407 |
$50K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
674 |
354 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,091 |
1,656 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,685 |
1,230 |
$36K |
| D0330 |
Panoramic radiographic image |
1,100 |
741 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,266 |
836 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
3,378 |
2,299 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,755 |
1,371 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,165 |
815 |
$27K |
| D2140 |
|
347 |
159 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
189 |
67 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
310 |
149 |
$14K |
| D2332 |
|
191 |
104 |
$12K |
| D2160 |
|
123 |
85 |
$11K |
| D4355 |
|
101 |
92 |
$6K |
| D2335 |
|
51 |
39 |
$6K |
| D1206 |
Topical application of fluoride varnish |
442 |
332 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
26 |
$4K |
| D4346 |
|
45 |
40 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$1K |
| D2330 |
|
13 |
12 |
$745.90 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$445.05 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$341.52 |
| D9430 |
|
42 |
40 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
3,128 |
2,060 |
$0.00 |