| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8030 |
|
625 |
598 |
$52K |
| D1110 |
Prophylaxis - adult |
1,497 |
1,379 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
817 |
270 |
$43K |
| D0330 |
Panoramic radiographic image |
790 |
716 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,464 |
1,355 |
$23K |
| D2394 |
|
268 |
118 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
714 |
636 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,024 |
936 |
$15K |
| D0274 |
Bitewings - four radiographic images |
793 |
744 |
$14K |
| D5110 |
|
36 |
30 |
$10K |
| D1120 |
Prophylaxis - child |
545 |
491 |
$10K |
| D2335 |
|
109 |
46 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
126 |
73 |
$8K |
| D5213 |
|
12 |
12 |
$6K |
| D5120 |
|
15 |
13 |
$6K |
| D5214 |
|
15 |
13 |
$5K |
| D8680 |
|
23 |
12 |
$4K |
| D7230 |
|
28 |
16 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
14 |
13 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
128 |
112 |
$3K |
| D0272 |
Bitewings - two radiographic images |
268 |
250 |
$2K |
| D1351 |
Sealant - per tooth |
114 |
24 |
$2K |
| D2931 |
|
20 |
16 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
413 |
386 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
365 |
323 |
$2K |
| D0340 |
|
28 |
26 |
$2K |
| D0470 |
|
56 |
27 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
12 |
$966.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$921.78 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$864.00 |
| D0350 |
|
80 |
27 |
$615.50 |