| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,450 |
4,365 |
$130K |
| D9110 |
|
1,092 |
977 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,878 |
1,850 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
941 |
926 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
502 |
300 |
$36K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
886 |
648 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
2,775 |
2,722 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
741 |
260 |
$19K |
| D2160 |
|
328 |
277 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
658 |
643 |
$13K |
| D2140 |
|
414 |
254 |
$11K |
| D2331 |
|
196 |
132 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
735 |
706 |
$7K |
| D0330 |
Panoramic radiographic image |
182 |
179 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
55 |
$6K |
| D5212 |
|
12 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
253 |
247 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
42 |
$2K |
| D2335 |
|
32 |
27 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
52 |
52 |
$900.00 |
| D2332 |
|
13 |
12 |
$648.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
25 |
$243.00 |