| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,334 |
9,209 |
$506K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,762 |
2,280 |
$322K |
| D0274 |
Bitewings - four radiographic images |
8,113 |
8,037 |
$305K |
| D0120 |
Periodic oral evaluation - established patient |
10,254 |
10,147 |
$253K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,610 |
642 |
$224K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,254 |
1,760 |
$206K |
| D2740 |
Crown - porcelain/ceramic |
276 |
185 |
$195K |
| D1120 |
Prophylaxis - child |
3,540 |
3,514 |
$179K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,624 |
5,579 |
$164K |
| D0220 |
Intraoral - periapical first radiographic image |
9,139 |
8,899 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,263 |
3,225 |
$143K |
| D0210 |
Intraoral - complete series of radiographic images |
1,879 |
1,839 |
$138K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,800 |
7,638 |
$106K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
150 |
108 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
785 |
555 |
$74K |
| D1351 |
Sealant - per tooth |
1,827 |
532 |
$72K |
| D0330 |
Panoramic radiographic image |
816 |
803 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
872 |
857 |
$35K |
| D9110 |
|
491 |
473 |
$21K |
| D2330 |
|
273 |
113 |
$20K |
| D2954 |
|
130 |
73 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
19 |
16 |
$11K |
| D2335 |
|
71 |
40 |
$10K |
| D2332 |
|
66 |
39 |
$8K |
| D0180 |
|
120 |
116 |
$5K |
| D2950 |
|
30 |
25 |
$4K |
| D2394 |
|
22 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
12 |
$2K |
| D1999 |
|
20 |
20 |
$0.00 |