| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,159 |
2,991 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,848 |
1,279 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,850 |
1,173 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
5,264 |
5,033 |
$96K |
| D1120 |
Prophylaxis - child |
2,758 |
2,654 |
$58K |
| D0330 |
Panoramic radiographic image |
1,202 |
1,113 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,238 |
3,125 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
701 |
332 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,281 |
1,222 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
664 |
607 |
$17K |
| D0272 |
Bitewings - two radiographic images |
805 |
778 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
268 |
244 |
$6K |
| D2330 |
|
101 |
69 |
$5K |
| D2335 |
|
31 |
24 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
37 |
26 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$955.50 |
| D2140 |
|
22 |
13 |
$924.00 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
25 |
$123.00 |