| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,382 |
6,285 |
$219K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,078 |
1,257 |
$179K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,757 |
1,646 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
7,853 |
7,723 |
$138K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,193 |
1,765 |
$122K |
| D1120 |
Prophylaxis - child |
2,757 |
2,723 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,696 |
2,654 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
2,028 |
1,851 |
$49K |
| D1206 |
Topical application of fluoride varnish |
2,323 |
2,297 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,541 |
1,509 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
546 |
440 |
$34K |
| D0330 |
Panoramic radiographic image |
634 |
623 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,169 |
1,151 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,396 |
2,260 |
$13K |
| D2140 |
|
204 |
120 |
$8K |
| D0272 |
Bitewings - two radiographic images |
724 |
720 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
115 |
102 |
$6K |
| D2332 |
|
64 |
38 |
$4K |
| D2330 |
|
37 |
24 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$1K |
| D2331 |
|
19 |
12 |
$1K |
| D2160 |
|
14 |
12 |
$910.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
15 |
$110.00 |
| D1999 |
|
977 |
790 |
$0.00 |