| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,117 |
6,114 |
$305K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,191 |
982 |
$163K |
| D0120 |
Periodic oral evaluation - established patient |
5,245 |
5,242 |
$138K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,302 |
727 |
$121K |
| D0274 |
Bitewings - four radiographic images |
3,296 |
3,295 |
$84K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
655 |
330 |
$53K |
| D2394 |
|
448 |
267 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
889 |
889 |
$48K |
| D0330 |
Panoramic radiographic image |
1,370 |
1,368 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
659 |
389 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
597 |
194 |
$31K |
| D4341 |
|
475 |
193 |
$23K |
| D1120 |
Prophylaxis - child |
440 |
440 |
$18K |
| D4910 |
|
297 |
297 |
$15K |
| D2332 |
|
137 |
78 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
961 |
961 |
$13K |
| D2335 |
|
71 |
42 |
$8K |
| D2331 |
|
63 |
45 |
$5K |
| D2330 |
|
73 |
43 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
242 |
232 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
168 |
165 |
$2K |