| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,283 |
5,282 |
$261K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,148 |
1,262 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
4,017 |
4,015 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,064 |
3,063 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
2,478 |
2,468 |
$88K |
| D0274 |
Bitewings - four radiographic images |
3,096 |
3,095 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
865 |
771 |
$65K |
| D0330 |
Panoramic radiographic image |
1,708 |
1,707 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
967 |
768 |
$52K |
| D9110 |
|
1,043 |
1,028 |
$25K |
| D2140 |
|
411 |
332 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,991 |
1,959 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,255 |
1,248 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
90 |
78 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
12 |
12 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
705 |
699 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
16 |
$2K |
| D2331 |
|
15 |
13 |
$1K |
| D2330 |
|
19 |
15 |
$1K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
67 |
67 |
$927.60 |
| D1999 |
|
299 |
256 |
$0.00 |