| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,498 |
9,004 |
$454K |
| D0120 |
Periodic oral evaluation - established patient |
10,261 |
9,240 |
$262K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,037 |
4,332 |
$214K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,262 |
946 |
$203K |
| D1120 |
Prophylaxis - child |
4,487 |
4,428 |
$154K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,459 |
689 |
$149K |
| D1351 |
Sealant - per tooth |
5,312 |
1,593 |
$148K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,093 |
297 |
$136K |
| D0274 |
Bitewings - four radiographic images |
4,724 |
3,720 |
$119K |
| D0272 |
Bitewings - two radiographic images |
4,830 |
4,726 |
$100K |
| D0330 |
Panoramic radiographic image |
2,544 |
2,264 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,445 |
4,378 |
$88K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
603 |
310 |
$73K |
| D7240 |
Removal of impacted tooth - completely bony |
200 |
73 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,721 |
1,699 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
1,243 |
1,027 |
$36K |
| D2931 |
|
211 |
129 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,698 |
2,328 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
417 |
153 |
$26K |
| D9248 |
|
201 |
196 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
730 |
668 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
146 |
146 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
73 |
30 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
875 |
608 |
$5K |
| D2160 |
|
37 |
18 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
24 |
$3K |
| D2140 |
|
30 |
17 |
$2K |