| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,701 |
7,699 |
$348K |
| D0120 |
Periodic oral evaluation - established patient |
8,694 |
8,690 |
$196K |
| D0330 |
Panoramic radiographic image |
2,915 |
2,914 |
$102K |
| D1120 |
Prophylaxis - child |
2,672 |
2,669 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,800 |
1,214 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,529 |
1,133 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,097 |
868 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,717 |
4,714 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,224 |
2,222 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
4,454 |
4,385 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,633 |
1,633 |
$36K |
| D9310 |
|
387 |
387 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,222 |
1,209 |
$11K |
| D7240 |
Removal of impacted tooth - completely bony |
42 |
26 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
685 |
681 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
107 |
88 |
$8K |
| D9110 |
|
240 |
238 |
$5K |
| D2750 |
|
12 |
12 |
$5K |
| D0272 |
Bitewings - two radiographic images |
336 |
336 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
29 |
24 |
$2K |
| D2954 |
|
16 |
13 |
$1K |
| D2331 |
|
17 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
91 |
$628.12 |