| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
20,947 |
20,947 |
$931K |
| D0120 |
Periodic oral evaluation - established patient |
23,576 |
23,561 |
$529K |
| D0274 |
Bitewings - four radiographic images |
21,563 |
21,563 |
$475K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,905 |
27,901 |
$357K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
674 |
525 |
$332K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,385 |
3,420 |
$275K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,326 |
2,919 |
$265K |
| D4341 |
|
4,066 |
2,256 |
$217K |
| D0220 |
Intraoral - periapical first radiographic image |
17,110 |
17,090 |
$180K |
| D0210 |
Intraoral - complete series of radiographic images |
21,889 |
21,848 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,626 |
6,624 |
$154K |
| D1120 |
Prophylaxis - child |
4,450 |
4,447 |
$151K |
| D9944 |
|
1,476 |
1,476 |
$142K |
| D9945 |
|
1,381 |
1,381 |
$137K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,518 |
1,281 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,218 |
1,039 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,935 |
7,932 |
$89K |
| D0330 |
Panoramic radiographic image |
2,817 |
2,816 |
$72K |
| D1351 |
Sealant - per tooth |
759 |
489 |
$52K |
| D0272 |
Bitewings - two radiographic images |
3,837 |
3,837 |
$48K |
| D2954 |
|
392 |
292 |
$42K |
| D3320 |
|
86 |
78 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
378 |
334 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,997 |
1,987 |
$22K |
| D7111 |
|
53 |
53 |
$2K |
| D9310 |
|
27 |
27 |
$1K |
| D2332 |
|
15 |
14 |
$1K |
| D2140 |
|
14 |
13 |
$1K |
| D2160 |
|
13 |
12 |
$1K |
| D9110 |
|
59 |
58 |
$840.08 |
| D1999 |
|
41 |
40 |
$0.00 |