| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
13,141 |
13,028 |
$687K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,887 |
6,246 |
$466K |
| D0120 |
Periodic oral evaluation - established patient |
20,730 |
20,530 |
$407K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,528 |
7,451 |
$378K |
| D1120 |
Prophylaxis - child |
14,800 |
14,650 |
$338K |
| D0330 |
Panoramic radiographic image |
4,407 |
4,376 |
$245K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,513 |
1,228 |
$127K |
| D8670 |
Periodic orthodontic treatment visit |
2,020 |
1,948 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,482 |
1,201 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,028 |
784 |
$47K |
| D8660 |
|
538 |
524 |
$41K |
| D9920 |
|
581 |
570 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,310 |
28,037 |
$21K |
| D1330 |
|
29,086 |
28,804 |
$21K |
| D0272 |
Bitewings - two radiographic images |
12,227 |
12,107 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,933 |
1,905 |
$16K |
| D1351 |
Sealant - per tooth |
9,212 |
3,073 |
$15K |
| D0274 |
Bitewings - four radiographic images |
13,310 |
13,195 |
$14K |
| D2740 |
Crown - porcelain/ceramic |
18 |
15 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
3,168 |
3,119 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13 |
12 |
$2K |
| D3120 |
|
1,210 |
969 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
375 |
366 |
$816.88 |
| D9996 |
|
22 |
20 |
$431.23 |
| D9986 |
|
192 |
186 |
$0.00 |
| D8680 |
|
16 |
15 |
$0.00 |
| D9987 |
|
28 |
28 |
$0.00 |