| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,068 |
6,889 |
$273K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,661 |
1,725 |
$225K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,044 |
1,692 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
8,321 |
8,138 |
$160K |
| D0274 |
Bitewings - four radiographic images |
6,897 |
6,725 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,158 |
3,081 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,341 |
4,258 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,225 |
527 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,107 |
8,518 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
10,447 |
10,101 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
972 |
916 |
$59K |
| D1120 |
Prophylaxis - child |
2,211 |
2,176 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
444 |
295 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,426 |
1,375 |
$36K |
| D2331 |
|
294 |
180 |
$26K |
| D2330 |
|
327 |
198 |
$23K |
| D0330 |
Panoramic radiographic image |
272 |
268 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,152 |
1,131 |
$13K |
| D2394 |
|
103 |
81 |
$9K |
| D1351 |
Sealant - per tooth |
310 |
63 |
$8K |
| D2332 |
|
41 |
25 |
$3K |
| D1320 |
|
84 |
82 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
12 |
$864.90 |
| D2140 |
|
20 |
13 |
$760.00 |
| D0240 |
|
72 |
27 |
$696.00 |