| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
19,358 |
6,524 |
$1.04M |
| D1120 |
Prophylaxis - child |
21,827 |
19,280 |
$889K |
| D4341 |
|
4,969 |
1,960 |
$772K |
| D0120 |
Periodic oral evaluation - established patient |
25,791 |
22,738 |
$714K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,764 |
19,250 |
$562K |
| D4342 |
|
3,327 |
1,361 |
$334K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,528 |
3,257 |
$302K |
| D1110 |
Prophylaxis - adult |
5,323 |
4,742 |
$232K |
| D0274 |
Bitewings - four radiographic images |
13,213 |
11,813 |
$232K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
849 |
578 |
$230K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,186 |
2,325 |
$229K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,923 |
6,116 |
$154K |
| D0220 |
Intraoral - periapical first radiographic image |
18,409 |
16,199 |
$109K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,073 |
619 |
$92K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,556 |
1,032 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,167 |
14,340 |
$90K |
| D9110 |
|
1,686 |
1,607 |
$90K |
| D0140 |
Limited oral evaluation - problem focused |
4,991 |
4,460 |
$87K |
| D2160 |
|
1,038 |
725 |
$83K |
| D2950 |
|
792 |
597 |
$51K |
| D2332 |
|
568 |
341 |
$45K |
| D0272 |
Bitewings - two radiographic images |
4,538 |
3,996 |
$44K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
650 |
439 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
598 |
361 |
$39K |
| D2335 |
|
353 |
253 |
$27K |
| D2140 |
|
677 |
512 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
1,276 |
1,170 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
73 |
66 |
$17K |
| D4910 |
|
175 |
175 |
$9K |
| D2940 |
|
72 |
54 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$401.05 |
| D0270 |
|
46 |
37 |
$240.80 |
| D1999 |
|
8,673 |
8,012 |
$0.00 |