| Code | Description | Claims | Beneficiaries | Total Paid |
| D0120 |
Periodic oral evaluation - established patient |
7,172 |
6,589 |
$187K |
| D1110 |
Prophylaxis - adult |
4,291 |
4,029 |
$185K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,480 |
2,298 |
$167K |
| D1120 |
Prophylaxis - child |
4,664 |
4,002 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,914 |
5,260 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,127 |
2,761 |
$80K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
158 |
111 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,070 |
590 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,901 |
1,023 |
$48K |
| D9999 |
Unspecified adjunctive procedure, by report |
994 |
918 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
6,864 |
6,094 |
$40K |
| D0274 |
Bitewings - four radiographic images |
3,884 |
3,700 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,697 |
7,002 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
846 |
340 |
$27K |
| D9430 |
|
1,624 |
1,574 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
1,002 |
934 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,989 |
1,842 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
388 |
181 |
$10K |
| D1310 |
|
970 |
886 |
$6K |
| D3320 |
|
35 |
26 |
$6K |
| D4341 |
|
171 |
70 |
$5K |
| D2332 |
|
166 |
85 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
1,156 |
1,014 |
$5K |
| D1999 |
|
2,441 |
2,338 |
$4K |
| D1351 |
Sealant - per tooth |
133 |
29 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
70 |
70 |
$4K |
| D0270 |
|
1,092 |
1,020 |
$2K |
| D2331 |
|
67 |
39 |
$2K |
| D2394 |
|
36 |
17 |
$831.00 |
| D1206 |
Topical application of fluoride varnish |
46 |
45 |
$576.00 |
| D0601 |
|
871 |
718 |
$480.00 |
| D0602 |
|
25 |
25 |
$240.00 |
| D9993 |
|
1,172 |
1,072 |
$65.00 |
| D1330 |
|
501 |
301 |
$0.00 |
| D9986 |
|
497 |
449 |
$0.00 |