| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
7,283 |
6,439 |
$197K |
| D1110 |
Prophylaxis - adult |
4,009 |
3,970 |
$190K |
| D0330 |
Panoramic radiographic image |
3,082 |
3,056 |
$190K |
| D0274 |
Bitewings - four radiographic images |
4,260 |
4,235 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,508 |
1,210 |
$127K |
| D3320 |
|
312 |
268 |
$119K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,343 |
871 |
$106K |
| D1206 |
Topical application of fluoride varnish |
3,743 |
3,701 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
6,728 |
6,536 |
$79K |
| D2140 |
|
1,255 |
667 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,081 |
651 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,151 |
5,034 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,112 |
2,098 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,156 |
2,136 |
$54K |
| D2332 |
|
447 |
235 |
$46K |
| D2330 |
|
737 |
433 |
$45K |
| D3310 |
|
97 |
78 |
$30K |
| D2160 |
|
214 |
185 |
$21K |
| D1330 |
|
3,311 |
3,276 |
$21K |
| D2331 |
|
211 |
141 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
288 |
100 |
$14K |
| D1120 |
Prophylaxis - child |
342 |
342 |
$12K |
| D9110 |
|
264 |
253 |
$11K |
| D1351 |
Sealant - per tooth |
266 |
38 |
$7K |
| D2335 |
|
56 |
39 |
$6K |
| D2161 |
|
41 |
38 |
$5K |
| D1354 |
|
120 |
55 |
$4K |
| D4355 |
|
63 |
63 |
$600.80 |
| D9985 |
|
157 |
139 |
$180.08 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
93 |
32 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$0.00 |