| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,386 |
8,972 |
$322K |
| D0120 |
Periodic oral evaluation - established patient |
9,269 |
8,905 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,847 |
1,922 |
$152K |
| D0210 |
Intraoral - complete series of radiographic images |
2,008 |
1,831 |
$109K |
| D0274 |
Bitewings - four radiographic images |
5,279 |
5,022 |
$105K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,231 |
914 |
$79K |
| D0330 |
Panoramic radiographic image |
1,918 |
1,799 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,419 |
1,027 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,446 |
673 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,447 |
2,321 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
2,516 |
2,355 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,081 |
2,988 |
$49K |
| D1120 |
Prophylaxis - child |
2,104 |
2,038 |
$44K |
| D2394 |
|
247 |
214 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
3,312 |
3,089 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,033 |
1,001 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
170 |
114 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,414 |
1,203 |
$6K |
| D2140 |
|
129 |
88 |
$5K |
| D2160 |
|
40 |
29 |
$3K |
| D2331 |
|
31 |
25 |
$2K |
| D0270 |
|
351 |
326 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
54 |
12 |
$1K |
| D1999 |
|
60 |
56 |
$0.00 |