| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,234 |
6,231 |
$340K |
| D0120 |
Periodic oral evaluation - established patient |
9,063 |
9,062 |
$247K |
| D2740 |
Crown - porcelain/ceramic |
385 |
355 |
$226K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,974 |
1,743 |
$207K |
| D1120 |
Prophylaxis - child |
3,279 |
3,279 |
$139K |
| D0210 |
Intraoral - complete series of radiographic images |
3,348 |
3,259 |
$124K |
| D0274 |
Bitewings - four radiographic images |
3,908 |
3,908 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,367 |
1,258 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,830 |
2,829 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
983 |
805 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,653 |
4,653 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
560 |
506 |
$63K |
| D4910 |
|
842 |
842 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,134 |
2,963 |
$40K |
| D0330 |
Panoramic radiographic image |
895 |
895 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,287 |
1,250 |
$17K |
| D4342 |
|
304 |
217 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,133 |
1,101 |
$11K |
| D1206 |
Topical application of fluoride varnish |
404 |
404 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
25 |
$6K |
| D2331 |
|
42 |
41 |
$5K |
| D4341 |
|
39 |
26 |
$3K |
| D0270 |
|
207 |
198 |
$3K |
| D9110 |
|
80 |
78 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
54 |
54 |
$876.18 |
| D2330 |
|
12 |
12 |
$766.76 |
| D0350 |
|
28 |
28 |
$342.16 |
| D1999 |
|
39 |
39 |
$0.00 |