| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,978 |
1,975 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,535 |
3,530 |
$90K |
| D0274 |
Bitewings - four radiographic images |
1,998 |
1,995 |
$50K |
| D1120 |
Prophylaxis - child |
1,279 |
1,277 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
584 |
442 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,610 |
3,597 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
443 |
376 |
$32K |
| D1351 |
Sealant - per tooth |
682 |
203 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,934 |
1,931 |
$25K |
| D2161 |
|
239 |
204 |
$25K |
| D2160 |
|
249 |
213 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,068 |
3,063 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,160 |
1,158 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
188 |
155 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
114 |
97 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
114 |
$8K |
| D2335 |
|
58 |
46 |
$7K |
| D2394 |
|
36 |
29 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
53 |
45 |
$3K |
| D1999 |
|
25 |
25 |
$1K |
| D2331 |
|
16 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
68 |
$790.99 |
| D2140 |
|
13 |
12 |
$654.20 |