| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,291 |
5,291 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
7,524 |
7,524 |
$153K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,553 |
1,035 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
763 |
629 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,146 |
5,131 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
5,128 |
5,120 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
818 |
605 |
$46K |
| D0272 |
Bitewings - two radiographic images |
3,140 |
3,140 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,130 |
1,130 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,431 |
1,431 |
$16K |
| D1120 |
Prophylaxis - child |
436 |
436 |
$14K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
31 |
30 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
147 |
137 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
132 |
115 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
437 |
437 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
555 |
555 |
$3K |
| D2954 |
|
27 |
26 |
$3K |
| D1351 |
Sealant - per tooth |
31 |
14 |
$2K |
| D2140 |
|
16 |
12 |
$483.16 |
| D1999 |
|
104 |
100 |
$0.00 |