| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,772 |
2,574 |
$121K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,124 |
607 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
875 |
540 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,069 |
1,907 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,786 |
2,597 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,104 |
984 |
$39K |
| D1354 |
|
430 |
78 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,514 |
1,393 |
$31K |
| D0330 |
Panoramic radiographic image |
680 |
625 |
$29K |
| D1120 |
Prophylaxis - child |
757 |
701 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
547 |
509 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,376 |
1,261 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
242 |
158 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
139 |
92 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
214 |
204 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
25 |
$6K |
| D0272 |
Bitewings - two radiographic images |
322 |
296 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
143 |
92 |
$863.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
348 |
329 |
$806.04 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
37 |
27 |
$324.56 |