| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,906 |
4,723 |
$212K |
| D0210 |
Intraoral - complete series of radiographic images |
2,424 |
2,328 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
6,501 |
6,184 |
$154K |
| D0272 |
Bitewings - two radiographic images |
4,155 |
3,997 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
944 |
501 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
4,513 |
4,112 |
$69K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
987 |
550 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,989 |
2,878 |
$54K |
| D0240 |
|
2,293 |
1,172 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
631 |
188 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
951 |
937 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,934 |
1,666 |
$22K |
| D1206 |
Topical application of fluoride varnish |
985 |
957 |
$18K |
| D2160 |
|
171 |
108 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
418 |
373 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
85 |
40 |
$9K |
| D2140 |
|
83 |
55 |
$4K |
| D1120 |
Prophylaxis - child |
69 |
65 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
24 |
$2K |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$725.97 |