| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D5110 |
|
353 |
339 |
$220K |
| D0330 |
Panoramic radiographic image |
4,868 |
4,697 |
$210K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,281 |
6,045 |
$166K |
| D5120 |
|
275 |
264 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,699 |
1,578 |
$158K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,231 |
1,639 |
$147K |
| D1110 |
Prophylaxis - adult |
2,949 |
2,870 |
$137K |
| D2335 |
|
1,360 |
732 |
$106K |
| D1120 |
Prophylaxis - child |
1,812 |
1,760 |
$93K |
| D2332 |
|
999 |
573 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,428 |
2,371 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
905 |
603 |
$59K |
| D2331 |
|
734 |
457 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,675 |
2,600 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
253 |
144 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
351 |
350 |
$9K |
| D9110 |
|
434 |
405 |
$9K |
| D2160 |
|
162 |
121 |
$9K |
| D2140 |
|
230 |
107 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
198 |
121 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
730 |
674 |
$5K |
| D1351 |
Sealant - per tooth |
65 |
14 |
$2K |
| D2330 |
|
36 |
26 |
$2K |