| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,298 |
7,287 |
$273K |
| D0120 |
Periodic oral evaluation - established patient |
9,776 |
9,749 |
$182K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,169 |
1,797 |
$153K |
| D0274 |
Bitewings - four radiographic images |
6,125 |
6,122 |
$108K |
| D2750 |
|
122 |
98 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
2,059 |
2,053 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,869 |
4,862 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
525 |
464 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
3,228 |
3,218 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,294 |
2,293 |
$20K |
| D1120 |
Prophylaxis - child |
715 |
715 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
317 |
274 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
107 |
104 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
1,118 |
1,113 |
$9K |
| D0272 |
Bitewings - two radiographic images |
104 |
104 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D0270 |
|
12 |
12 |
$0.00 |
| D1999 |
|
27 |
27 |
$0.00 |
| D1330 |
|
831 |
827 |
$0.00 |