| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
12,086 |
11,729 |
$389K |
| D1120 |
Prophylaxis - child |
8,385 |
8,269 |
$367K |
| D0120 |
Periodic oral evaluation - established patient |
14,116 |
13,734 |
$364K |
| D1110 |
Prophylaxis - adult |
9,695 |
9,262 |
$330K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,679 |
14,315 |
$328K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,307 |
2,820 |
$313K |
| D0330 |
Panoramic radiographic image |
5,626 |
5,177 |
$313K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
294 |
250 |
$194K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,594 |
4,215 |
$194K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,676 |
1,463 |
$183K |
| D0220 |
Intraoral - periapical first radiographic image |
13,097 |
12,371 |
$162K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,434 |
9,746 |
$129K |
| D0140 |
Limited oral evaluation - problem focused |
4,294 |
3,936 |
$122K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,021 |
781 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,121 |
482 |
$70K |
| D2791 |
|
144 |
129 |
$52K |
| D2954 |
|
381 |
304 |
$48K |
| D1351 |
Sealant - per tooth |
1,020 |
265 |
$39K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
56 |
41 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
451 |
367 |
$25K |
| D2332 |
|
153 |
104 |
$14K |
| D2335 |
|
120 |
80 |
$13K |
| D2160 |
|
107 |
95 |
$8K |
| D0272 |
Bitewings - two radiographic images |
251 |
248 |
$7K |
| D2331 |
|
82 |
66 |
$6K |
| D9310 |
|
283 |
262 |
$6K |
| D2140 |
|
117 |
95 |
$6K |
| D2330 |
|
80 |
50 |
$4K |
| D1320 |
|
1,068 |
1,043 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
14 |
$3K |
| D2394 |
|
13 |
13 |
$1K |