| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
5,041 |
983 |
$418K |
| D1110 |
Prophylaxis - adult |
6,873 |
6,557 |
$309K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,957 |
1,922 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
7,853 |
7,489 |
$171K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,971 |
1,277 |
$159K |
| D0274 |
Bitewings - four radiographic images |
3,516 |
3,307 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
2,857 |
2,282 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,422 |
601 |
$105K |
| D0140 |
Limited oral evaluation - problem focused |
2,368 |
2,213 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,361 |
2,241 |
$71K |
| D0330 |
Panoramic radiographic image |
1,608 |
1,522 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,733 |
3,557 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,012 |
667 |
$50K |
| D2332 |
|
364 |
227 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,698 |
3,399 |
$40K |
| D1120 |
Prophylaxis - child |
1,311 |
1,248 |
$35K |
| D2394 |
|
306 |
207 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,138 |
2,344 |
$31K |
| D2331 |
|
324 |
229 |
$30K |
| D2335 |
|
194 |
123 |
$30K |
| D4910 |
|
285 |
267 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
118 |
69 |
$14K |
| D4342 |
|
144 |
42 |
$8K |
| D2330 |
|
69 |
54 |
$5K |
| D0272 |
Bitewings - two radiographic images |
162 |
161 |
$3K |
| D1999 |
|
592 |
520 |
$117.93 |