| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,169 |
6,175 |
$331K |
| D0120 |
Periodic oral evaluation - established patient |
8,453 |
7,405 |
$178K |
| D0274 |
Bitewings - four radiographic images |
4,126 |
3,540 |
$131K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,873 |
775 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,541 |
3,110 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,121 |
689 |
$80K |
| D1120 |
Prophylaxis - child |
1,552 |
1,372 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,894 |
1,608 |
$63K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
524 |
234 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,109 |
581 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
437 |
389 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,975 |
1,628 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
421 |
363 |
$16K |
| D1351 |
Sealant - per tooth |
120 |
29 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
92 |
85 |
$2K |
| D9110 |
|
59 |
53 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
41 |
26 |
$478.00 |
| D1330 |
|
18 |
18 |
$0.00 |