| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,712 |
6,536 |
$350K |
| D0274 |
Bitewings - four radiographic images |
6,094 |
5,937 |
$220K |
| D0120 |
Periodic oral evaluation - established patient |
8,791 |
8,610 |
$211K |
| D1120 |
Prophylaxis - child |
3,613 |
3,558 |
$176K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,967 |
4,856 |
$142K |
| D1351 |
Sealant - per tooth |
2,458 |
659 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
2,408 |
2,305 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,304 |
1,282 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,717 |
1,661 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,048 |
515 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
720 |
432 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
2,989 |
2,861 |
$45K |
| D2740 |
Crown - porcelain/ceramic |
44 |
30 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
363 |
185 |
$27K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
39 |
26 |
$21K |
| D0272 |
Bitewings - two radiographic images |
474 |
471 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
750 |
563 |
$9K |
| D9310 |
|
272 |
188 |
$9K |
| D8670 |
Periodic orthodontic treatment visit |
28 |
28 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
42 |
27 |
$6K |
| D2950 |
|
41 |
26 |
$6K |
| D8660 |
|
275 |
222 |
$4K |
| D4342 |
|
42 |
13 |
$4K |
| D1330 |
|
168 |
151 |
$2K |
| D2954 |
|
13 |
12 |
$2K |
| D0470 |
|
99 |
69 |
$0.00 |
| D0330 |
Panoramic radiographic image |
196 |
139 |
$0.00 |
| D0350 |
|
134 |
89 |
$0.00 |
| D0340 |
|
143 |
93 |
$0.00 |