| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,608 |
3,463 |
$117K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,005 |
615 |
$111K |
| D0330 |
Panoramic radiographic image |
1,679 |
1,587 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
3,898 |
3,735 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
824 |
513 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
670 |
411 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,384 |
1,313 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,790 |
1,699 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,934 |
1,835 |
$28K |
| D1120 |
Prophylaxis - child |
1,390 |
1,326 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,063 |
967 |
$23K |
| D2335 |
|
237 |
125 |
$19K |
| D2394 |
|
260 |
186 |
$18K |
| D2332 |
|
163 |
84 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
175 |
84 |
$8K |
| D0272 |
Bitewings - two radiographic images |
702 |
673 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
779 |
726 |
$3K |
| D1351 |
Sealant - per tooth |
118 |
28 |
$2K |
| D2330 |
|
23 |
15 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
12 |
$1K |
| D2331 |
|
15 |
13 |
$790.14 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$366.88 |
| D0230 |
Intraoral - periapical each additional radiographic image |
41 |
13 |
$180.00 |