| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
13,359 |
13,013 |
$557K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
845 |
716 |
$485K |
| D0120 |
Periodic oral evaluation - established patient |
18,747 |
18,333 |
$443K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,411 |
20,878 |
$439K |
| D1120 |
Prophylaxis - child |
10,404 |
10,172 |
$341K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,645 |
2,380 |
$332K |
| D2740 |
Crown - porcelain/ceramic |
640 |
424 |
$329K |
| D0330 |
Panoramic radiographic image |
6,731 |
6,533 |
$273K |
| D0272 |
Bitewings - two radiographic images |
12,013 |
11,622 |
$207K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,909 |
5,688 |
$164K |
| D2950 |
|
1,258 |
896 |
$119K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,667 |
1,034 |
$100K |
| D1351 |
Sealant - per tooth |
3,593 |
966 |
$99K |
| D0274 |
Bitewings - four radiographic images |
2,332 |
2,300 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
607 |
373 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,883 |
3,601 |
$41K |
| D3320 |
|
85 |
65 |
$41K |
| D2335 |
|
419 |
172 |
$37K |
| D3310 |
|
59 |
29 |
$26K |
| D1206 |
Topical application of fluoride varnish |
774 |
755 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
62 |
15 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,222 |
674 |
$6K |
| D1353 |
|
91 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
102 |
$2K |
| D2332 |
|
20 |
12 |
$2K |