| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,829 |
4,809 |
$228K |
| D0330 |
Panoramic radiographic image |
3,499 |
3,478 |
$204K |
| D2750 |
|
316 |
247 |
$177K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,805 |
960 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,317 |
3,304 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
4,676 |
4,659 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,138 |
491 |
$100K |
| D1120 |
Prophylaxis - child |
2,398 |
2,396 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,264 |
3,260 |
$76K |
| D0140 |
Limited oral evaluation - problem focused |
1,465 |
1,457 |
$52K |
| D2950 |
|
234 |
189 |
$40K |
| D3320 |
|
75 |
67 |
$33K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
54 |
49 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
108 |
$18K |
| D5213 |
|
15 |
15 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,136 |
1,107 |
$15K |
| D5214 |
|
15 |
15 |
$14K |
| D7111 |
|
200 |
149 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
119 |
77 |
$9K |
| D2140 |
|
27 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$428.65 |