| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
6,067 |
2,055 |
$457K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,720 |
2,552 |
$352K |
| D2332 |
|
3,483 |
1,782 |
$218K |
| D1110 |
Prophylaxis - adult |
4,372 |
4,338 |
$184K |
| D2161 |
|
2,563 |
1,459 |
$176K |
| D0330 |
Panoramic radiographic image |
4,153 |
4,117 |
$168K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,451 |
5,407 |
$148K |
| D2160 |
|
2,530 |
1,288 |
$147K |
| D2394 |
|
2,106 |
1,336 |
$146K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,828 |
1,214 |
$109K |
| D0274 |
Bitewings - four radiographic images |
4,373 |
4,338 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,037 |
716 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
988 |
529 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
734 |
475 |
$36K |
| D1120 |
Prophylaxis - child |
454 |
447 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,920 |
2,842 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,337 |
1,323 |
$20K |
| D5110 |
|
14 |
14 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,266 |
680 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
100 |
68 |
$7K |
| D2140 |
|
89 |
56 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
62 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
19 |
$875.10 |
| D2331 |
|
14 |
12 |
$740.85 |
| D9110 |
|
28 |
26 |
$572.04 |
| D9986 |
|
85 |
73 |
$0.00 |