| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,093 |
4,069 |
$231K |
| D0274 |
Bitewings - four radiographic images |
3,007 |
2,997 |
$116K |
| D0330 |
Panoramic radiographic image |
1,445 |
1,442 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
2,883 |
2,865 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,542 |
2,535 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
2,125 |
2,099 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
3,809 |
3,743 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
598 |
194 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
491 |
255 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,325 |
2,623 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
300 |
96 |
$36K |
| D2721 |
|
33 |
14 |
$35K |
| D1120 |
Prophylaxis - child |
855 |
854 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
684 |
682 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
206 |
103 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
104 |
61 |
$10K |
| D4341 |
|
41 |
13 |
$7K |
| D2161 |
|
35 |
25 |
$4K |
| D1206 |
Topical application of fluoride varnish |
107 |
107 |
$4K |
| D0272 |
Bitewings - two radiographic images |
84 |
84 |
$3K |
| D1351 |
Sealant - per tooth |
60 |
12 |
$2K |
| D1330 |
|
52 |
52 |
$2K |