| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,690 |
3,690 |
$158K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
673 |
645 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
5,991 |
5,988 |
$131K |
| D0210 |
Intraoral - complete series of radiographic images |
2,681 |
2,676 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,785 |
2,785 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,336 |
3,313 |
$56K |
| D9310 |
|
454 |
454 |
$34K |
| D9243 |
|
187 |
186 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
379 |
319 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
424 |
314 |
$25K |
| D2750 |
|
55 |
53 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,453 |
1,453 |
$16K |
| D0330 |
Panoramic radiographic image |
817 |
817 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
355 |
195 |
$13K |
| D9239 |
|
175 |
174 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
853 |
844 |
$11K |
| D0160 |
|
224 |
224 |
$6K |
| D2160 |
|
67 |
53 |
$4K |
| D1120 |
Prophylaxis - child |
127 |
127 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
121 |
$4K |
| D2954 |
|
27 |
27 |
$2K |
| D4341 |
|
130 |
91 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
29 |
25 |
$2K |
| D9110 |
|
38 |
38 |
$592.90 |