| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,648 |
10,239 |
$416K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,688 |
2,070 |
$382K |
| D0120 |
Periodic oral evaluation - established patient |
17,349 |
16,675 |
$341K |
| D1120 |
Prophylaxis - child |
8,043 |
7,734 |
$181K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,278 |
9,908 |
$175K |
| D0140 |
Limited oral evaluation - problem focused |
6,672 |
6,053 |
$170K |
| D0272 |
Bitewings - two radiographic images |
13,638 |
13,137 |
$155K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,425 |
1,678 |
$136K |
| D0330 |
Panoramic radiographic image |
2,425 |
2,267 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,172 |
2,060 |
$64K |
| D5110 |
|
116 |
114 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
821 |
455 |
$44K |
| D5120 |
|
60 |
54 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
4,150 |
3,805 |
$23K |
| D2331 |
|
241 |
144 |
$20K |
| D2160 |
|
233 |
185 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
168 |
117 |
$12K |
| D2140 |
|
175 |
123 |
$7K |
| D2332 |
|
18 |
13 |
$1K |
| D2330 |
|
18 |
14 |
$908.09 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
25 |
13 |
$736.23 |
| D0230 |
Intraoral - periapical each additional radiographic image |
63 |
36 |
$246.00 |