| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9110 |
|
10,623 |
8,938 |
$651K |
| D0230 |
Intraoral - periapical each additional radiographic image |
102,748 |
16,213 |
$272K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,446 |
2,264 |
$268K |
| D1110 |
Prophylaxis - adult |
3,399 |
3,386 |
$265K |
| D0120 |
Periodic oral evaluation - established patient |
4,470 |
4,457 |
$254K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,879 |
3,869 |
$232K |
| D1120 |
Prophylaxis - child |
4,555 |
4,540 |
$161K |
| D0210 |
Intraoral - complete series of radiographic images |
2,391 |
2,380 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,537 |
8,478 |
$103K |
| D2140 |
|
1,765 |
1,016 |
$86K |
| D0274 |
Bitewings - four radiographic images |
4,887 |
4,863 |
$85K |
| D1351 |
Sealant - per tooth |
4,022 |
780 |
$83K |
| D0350 |
|
13,919 |
3,180 |
$76K |
| D2160 |
|
978 |
715 |
$69K |
| D0270 |
|
12,131 |
9,458 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,088 |
542 |
$47K |
| D4341 |
|
638 |
163 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
662 |
263 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
4,793 |
3,820 |
$38K |
| D3221 |
|
371 |
316 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,405 |
1,375 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
26 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
156 |
91 |
$9K |
| D2330 |
|
117 |
51 |
$7K |
| D7510 |
|
75 |
70 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
33 |
$4K |
| D1999 |
|
280 |
245 |
$271.25 |