| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,018 |
8,559 |
$416K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,388 |
2,890 |
$355K |
| D0140 |
Limited oral evaluation - problem focused |
9,529 |
8,596 |
$243K |
| D0120 |
Periodic oral evaluation - established patient |
8,197 |
7,782 |
$223K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,650 |
12,080 |
$223K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,410 |
1,371 |
$221K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,625 |
1,708 |
$220K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,944 |
4,742 |
$177K |
| D0220 |
Intraoral - periapical first radiographic image |
13,469 |
11,885 |
$117K |
| D9110 |
|
2,051 |
1,790 |
$109K |
| D0274 |
Bitewings - four radiographic images |
6,874 |
6,500 |
$87K |
| D4341 |
|
2,234 |
591 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
952 |
592 |
$48K |
| D0272 |
Bitewings - two radiographic images |
5,110 |
4,920 |
$46K |
| D1120 |
Prophylaxis - child |
1,690 |
1,636 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
827 |
324 |
$33K |
| D1999 |
|
2,097 |
1,849 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,467 |
6,611 |
$17K |
| D9920 |
|
502 |
468 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
229 |
105 |
$11K |
| D0330 |
Panoramic radiographic image |
297 |
266 |
$8K |
| D2160 |
|
125 |
73 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$7K |
| D2332 |
|
51 |
30 |
$3K |
| D2335 |
|
16 |
12 |
$1K |
| D2140 |
|
20 |
14 |
$780.87 |
| D1330 |
|
414 |
301 |
$0.00 |