| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,738 |
3,227 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
4,076 |
3,462 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
2,854 |
2,315 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,167 |
674 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,144 |
1,865 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,383 |
2,869 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,523 |
2,146 |
$56K |
| D1120 |
Prophylaxis - child |
2,399 |
2,033 |
$53K |
| D2752 |
|
83 |
45 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
4,520 |
3,667 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,205 |
1,485 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
427 |
168 |
$22K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
55 |
31 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,163 |
1,121 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,381 |
1,182 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
286 |
84 |
$16K |
| D2952 |
|
111 |
61 |
$15K |
| D0330 |
Panoramic radiographic image |
308 |
184 |
$13K |
| D2740 |
Crown - porcelain/ceramic |
19 |
14 |
$13K |
| D2931 |
|
75 |
49 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
139 |
97 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
235 |
115 |
$6K |
| D3320 |
|
14 |
12 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
25 |
$3K |
| D1351 |
Sealant - per tooth |
77 |
12 |
$2K |
| D2140 |
|
35 |
25 |
$1K |
| D2160 |
|
12 |
12 |
$780.00 |