| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,936 |
2,921 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,628 |
813 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,491 |
2,462 |
$64K |
| D0330 |
Panoramic radiographic image |
1,196 |
1,182 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
646 |
271 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
648 |
624 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,880 |
1,867 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,601 |
1,543 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,998 |
1,990 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
595 |
334 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
430 |
164 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,283 |
1,265 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
230 |
140 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
942 |
938 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,819 |
2,682 |
$13K |
| D1120 |
Prophylaxis - child |
473 |
472 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
110 |
73 |
$6K |
| D2950 |
|
69 |
59 |
$5K |
| D2140 |
|
75 |
47 |
$3K |
| D1351 |
Sealant - per tooth |
105 |
27 |
$2K |
| D1206 |
Topical application of fluoride varnish |
146 |
145 |
$2K |
| D2332 |
|
14 |
12 |
$1K |
| D2330 |
|
14 |
12 |
$716.94 |
| D2160 |
|
12 |
12 |
$715.00 |
| D0272 |
Bitewings - two radiographic images |
18 |
18 |
$180.00 |