| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,972 |
2,922 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,516 |
483 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,064 |
482 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,186 |
2,146 |
$58K |
| D5213 |
|
114 |
112 |
$54K |
| D5214 |
|
80 |
72 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
2,080 |
2,046 |
$39K |
| D0330 |
Panoramic radiographic image |
1,004 |
977 |
$35K |
| D1351 |
Sealant - per tooth |
1,350 |
198 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,552 |
1,523 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
446 |
238 |
$27K |
| D5110 |
|
51 |
47 |
$24K |
| D9110 |
|
517 |
493 |
$15K |
| D1120 |
Prophylaxis - child |
512 |
507 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
783 |
768 |
$14K |
| D1330 |
|
1,662 |
1,607 |
$13K |
| D5120 |
|
28 |
27 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,763 |
1,667 |
$13K |
| D1310 |
|
1,484 |
1,428 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,117 |
923 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
202 |
202 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
134 |
80 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
96 |
89 |
$3K |
| D2331 |
|
26 |
14 |
$2K |
| D5422 |
|
80 |
76 |
$1K |
| D5421 |
|
60 |
60 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$190.24 |