| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,058 |
4,040 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
6,527 |
6,493 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,249 |
834 |
$74K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
969 |
621 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,035 |
4,012 |
$62K |
| D2394 |
|
757 |
488 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,846 |
2,835 |
$60K |
| D1120 |
Prophylaxis - child |
2,758 |
2,743 |
$57K |
| D0330 |
Panoramic radiographic image |
1,069 |
1,052 |
$52K |
| D2335 |
|
436 |
242 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
694 |
440 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,123 |
1,111 |
$35K |
| D2332 |
|
352 |
208 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
255 |
250 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,418 |
1,415 |
$15K |
| D2160 |
|
201 |
122 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
228 |
96 |
$13K |
| D2161 |
|
150 |
94 |
$12K |
| D1206 |
Topical application of fluoride varnish |
328 |
326 |
$9K |
| D1351 |
Sealant - per tooth |
388 |
116 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
136 |
97 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,054 |
1,046 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
173 |
169 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
607 |
261 |
$4K |
| D2140 |
|
90 |
56 |
$4K |
| D1354 |
|
19 |
12 |
$283.50 |