| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,957 |
8,922 |
$491K |
| D1110 |
Prophylaxis - adult |
4,203 |
4,179 |
$364K |
| D2740 |
Crown - porcelain/ceramic |
475 |
381 |
$226K |
| D1120 |
Prophylaxis - child |
5,908 |
5,891 |
$215K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,445 |
9,359 |
$194K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,105 |
3,099 |
$194K |
| D0274 |
Bitewings - four radiographic images |
8,383 |
8,353 |
$177K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,963 |
1,060 |
$170K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
294 |
266 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,375 |
985 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,291 |
7,285 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,301 |
1,298 |
$61K |
| D9430 |
|
1,612 |
1,561 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
663 |
465 |
$44K |
| D1206 |
Topical application of fluoride varnish |
2,638 |
2,604 |
$43K |
| D2954 |
|
365 |
317 |
$38K |
| D1351 |
Sealant - per tooth |
1,418 |
287 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
482 |
328 |
$26K |
| D0270 |
|
4,049 |
3,822 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
876 |
859 |
$10K |
| D0272 |
Bitewings - two radiographic images |
874 |
874 |
$10K |
| D2931 |
|
64 |
58 |
$8K |
| D3320 |
|
15 |
13 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
41 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$2K |
| D2160 |
|
18 |
14 |
$1K |
| D2140 |
|
16 |
12 |
$873.60 |