| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
13,405 |
12,926 |
$715K |
| D0274 |
Bitewings - four radiographic images |
14,905 |
14,373 |
$529K |
| D1120 |
Prophylaxis - child |
8,556 |
8,349 |
$421K |
| D0120 |
Periodic oral evaluation - established patient |
17,159 |
16,670 |
$421K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,888 |
11,594 |
$339K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,863 |
2,136 |
$327K |
| D0220 |
Intraoral - periapical first radiographic image |
19,911 |
18,851 |
$311K |
| D1351 |
Sealant - per tooth |
6,869 |
1,644 |
$277K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,699 |
5,490 |
$252K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,473 |
15,334 |
$240K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,912 |
1,503 |
$189K |
| D0140 |
Limited oral evaluation - problem focused |
4,363 |
4,170 |
$165K |
| D2740 |
Crown - porcelain/ceramic |
167 |
139 |
$117K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,344 |
694 |
$103K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
198 |
128 |
$103K |
| D0272 |
Bitewings - two radiographic images |
1,349 |
1,319 |
$39K |
| D2950 |
|
232 |
148 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
89 |
$11K |
| D2335 |
|
52 |
39 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
80 |
$6K |
| D2331 |
|
21 |
13 |
$2K |
| D2394 |
|
18 |
13 |
$2K |
| D2330 |
|
16 |
12 |
$1K |
| D1999 |
|
13,594 |
10,922 |
$0.00 |
| D9430 |
|
17 |
14 |
$0.00 |