| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
11,003 |
10,709 |
$578K |
| D2740 |
Crown - porcelain/ceramic |
568 |
442 |
$407K |
| D8670 |
Periodic orthodontic treatment visit |
1,570 |
1,348 |
$333K |
| D0120 |
Periodic oral evaluation - established patient |
10,731 |
10,460 |
$246K |
| D0210 |
Intraoral - complete series of radiographic images |
2,058 |
1,994 |
$145K |
| D0140 |
Limited oral evaluation - problem focused |
2,249 |
2,177 |
$90K |
| D0274 |
Bitewings - four radiographic images |
2,326 |
2,271 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
5,050 |
4,849 |
$80K |
| D1120 |
Prophylaxis - child |
1,201 |
1,189 |
$62K |
| D4342 |
|
754 |
287 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,532 |
3,183 |
$48K |
| D2950 |
|
285 |
227 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,480 |
1,444 |
$43K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
427 |
360 |
$31K |
| D1206 |
Topical application of fluoride varnish |
760 |
759 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
331 |
318 |
$13K |
| D9110 |
|
256 |
246 |
$11K |
| D1330 |
|
390 |
385 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
37 |
$5K |
| D1351 |
Sealant - per tooth |
102 |
24 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
13 |
$3K |
| D0272 |
Bitewings - two radiographic images |
60 |
60 |
$2K |
| D2160 |
|
13 |
12 |
$1K |
| D9310 |
|
12 |
12 |
$630.00 |
| D8660 |
|
25 |
24 |
$558.00 |