| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9610 |
|
3,496 |
2,690 |
$127K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
952 |
489 |
$49K |
| D1110 |
Prophylaxis - adult |
1,111 |
1,017 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,140 |
1,049 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,067 |
910 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
344 |
194 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,012 |
904 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
292 |
113 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
769 |
647 |
$17K |
| D1206 |
Topical application of fluoride varnish |
886 |
781 |
$13K |
| D4341 |
|
453 |
139 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,403 |
1,262 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
256 |
135 |
$10K |
| D0274 |
Bitewings - four radiographic images |
937 |
851 |
$9K |
| D9110 |
|
174 |
114 |
$5K |
| D0330 |
Panoramic radiographic image |
218 |
193 |
$4K |
| D1999 |
|
410 |
299 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
47 |
$3K |
| D9612 |
|
60 |
54 |
$2K |
| D9992 |
|
81 |
76 |
$1K |
| D2394 |
|
20 |
13 |
$853.88 |
| D1351 |
Sealant - per tooth |
95 |
15 |
$813.26 |
| D1120 |
Prophylaxis - child |
50 |
39 |
$686.42 |
| D2332 |
|
20 |
13 |
$651.06 |
| D0230 |
Intraoral - periapical each additional radiographic image |
324 |
244 |
$586.83 |
| D0270 |
|
48 |
44 |
$345.60 |
| D0460 |
|
15 |
13 |
$4.85 |