| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
19,590 |
19,268 |
$1.04M |
| D2740 |
Crown - porcelain/ceramic |
890 |
595 |
$624K |
| D0120 |
Periodic oral evaluation - established patient |
22,505 |
22,207 |
$542K |
| D0330 |
Panoramic radiographic image |
7,156 |
7,005 |
$496K |
| D0140 |
Limited oral evaluation - problem focused |
11,188 |
10,487 |
$427K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,831 |
3,106 |
$423K |
| D1120 |
Prophylaxis - child |
7,460 |
7,387 |
$378K |
| D0220 |
Intraoral - periapical first radiographic image |
24,089 |
22,670 |
$377K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
671 |
366 |
$375K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,215 |
13,060 |
$373K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,638 |
2,601 |
$367K |
| D0272 |
Bitewings - two radiographic images |
13,192 |
13,014 |
$331K |
| D2332 |
|
2,988 |
712 |
$329K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,809 |
964 |
$258K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,518 |
15,784 |
$237K |
| D2335 |
|
1,460 |
574 |
$198K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,472 |
4,413 |
$197K |
| D4341 |
|
1,452 |
445 |
$179K |
| D2950 |
|
898 |
582 |
$145K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,618 |
548 |
$132K |
| D7311 |
|
1,060 |
746 |
$123K |
| D2954 |
|
644 |
489 |
$117K |
| D1351 |
Sealant - per tooth |
2,437 |
651 |
$95K |
| D9110 |
|
1,641 |
1,496 |
$65K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
92 |
83 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
381 |
227 |
$30K |
| D2330 |
|
365 |
130 |
$25K |
| D3320 |
|
42 |
36 |
$20K |
| D9430 |
|
178 |
151 |
$3K |
| D2394 |
|
20 |
14 |
$3K |
| D1330 |
|
161 |
161 |
$2K |