| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,354 |
3,340 |
$279K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,720 |
1,579 |
$174K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
850 |
636 |
$128K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
877 |
574 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
322 |
107 |
$23K |
| D4341 |
|
377 |
159 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
392 |
162 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
154 |
154 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,395 |
1,387 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
442 |
440 |
$7K |
| D0330 |
Panoramic radiographic image |
411 |
410 |
$7K |
| D1120 |
Prophylaxis - child |
66 |
66 |
$3K |
| D4910 |
|
39 |
39 |
$3K |
| D2332 |
|
24 |
15 |
$3K |
| D2331 |
|
33 |
29 |
$1K |
| D0274 |
Bitewings - four radiographic images |
2,785 |
2,774 |
$933.47 |
| D0220 |
Intraoral - periapical first radiographic image |
3,099 |
3,065 |
$59.08 |
| D1208 |
Topical application of fluoride, excluding varnish |
272 |
271 |
$13.55 |
| D0120 |
Periodic oral evaluation - established patient |
1,975 |
1,967 |
$-19.55 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,536 |
2,522 |
$-471.72 |