| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,728 |
3,277 |
$128K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,186 |
896 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
3,418 |
2,992 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,131 |
1,860 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,801 |
2,456 |
$56K |
| D0330 |
Panoramic radiographic image |
1,114 |
914 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,263 |
2,043 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
506 |
490 |
$27K |
| D1120 |
Prophylaxis - child |
1,328 |
1,228 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
347 |
236 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
329 |
192 |
$16K |
| D0272 |
Bitewings - two radiographic images |
440 |
438 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
31 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
12 |
$864.00 |
| D0140 |
Limited oral evaluation - problem focused |
38 |
38 |
$716.56 |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
127 |
$557.75 |