| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,401 |
5,233 |
$207K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,073 |
2,071 |
$188K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,718 |
1,253 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
6,039 |
5,876 |
$115K |
| D0274 |
Bitewings - four radiographic images |
4,674 |
4,544 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,366 |
951 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,237 |
579 |
$73K |
| D0330 |
Panoramic radiographic image |
1,274 |
1,218 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,997 |
2,946 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
7,170 |
6,866 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,090 |
5,613 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,177 |
1,098 |
$27K |
| D2331 |
|
427 |
289 |
$26K |
| D2394 |
|
323 |
235 |
$26K |
| D1120 |
Prophylaxis - child |
1,140 |
1,121 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
830 |
787 |
$25K |
| D2335 |
|
194 |
143 |
$19K |
| D2332 |
|
230 |
163 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,177 |
1,149 |
$12K |
| D2330 |
|
165 |
123 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
47 |
32 |
$3K |
| D2160 |
|
18 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
24 |
$811.10 |
| D2140 |
|
16 |
13 |
$672.00 |