| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,177 |
913 |
$542K |
| D1110 |
Prophylaxis - adult |
12,612 |
12,605 |
$519K |
| D0120 |
Periodic oral evaluation - established patient |
20,427 |
20,416 |
$433K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,140 |
3,143 |
$376K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,888 |
19,801 |
$330K |
| D1120 |
Prophylaxis - child |
9,146 |
9,142 |
$296K |
| D1351 |
Sealant - per tooth |
4,877 |
2,135 |
$248K |
| D3240 |
|
946 |
518 |
$225K |
| D2394 |
|
1,822 |
1,071 |
$216K |
| D2954 |
|
1,997 |
1,562 |
$211K |
| D0220 |
Intraoral - periapical first radiographic image |
21,380 |
21,139 |
$207K |
| D0274 |
Bitewings - four radiographic images |
10,273 |
10,269 |
$192K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
600 |
513 |
$150K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
287 |
195 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,586 |
11,580 |
$126K |
| D4341 |
|
2,386 |
1,089 |
$107K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,084 |
660 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
8,542 |
8,181 |
$77K |
| D3320 |
|
376 |
319 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,493 |
1,044 |
$62K |
| D2335 |
|
482 |
240 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,462 |
1,462 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,413 |
1,412 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,881 |
1,870 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
364 |
301 |
$14K |
| D2332 |
|
104 |
57 |
$8K |
| D3310 |
|
38 |
28 |
$7K |
| D9110 |
|
12 |
12 |
$189.65 |
| D1999 |
|
89 |
78 |
$0.00 |