| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,405 |
2,392 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
2,429 |
2,416 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,858 |
2,842 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
839 |
478 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
631 |
391 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
545 |
266 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,852 |
2,772 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,819 |
1,895 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,121 |
1,110 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
740 |
736 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
708 |
682 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
318 |
190 |
$19K |
| D4341 |
|
214 |
83 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
281 |
281 |
$14K |
| D1120 |
Prophylaxis - child |
255 |
253 |
$10K |
| D2331 |
|
108 |
69 |
$7K |
| D0603 |
|
419 |
417 |
$4K |
| D2160 |
|
37 |
30 |
$2K |
| D0601 |
|
185 |
185 |
$2K |
| D0602 |
|
185 |
185 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D9630 |
|
59 |
59 |
$1K |
| D2330 |
|
19 |
13 |
$972.00 |
| D1999 |
|
226 |
209 |
$721.00 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$373.50 |
| D0270 |
|
27 |
26 |
$249.00 |