| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
11,865 |
10,943 |
$597K |
| D0274 |
Bitewings - four radiographic images |
13,206 |
12,259 |
$453K |
| D0120 |
Periodic oral evaluation - established patient |
16,494 |
15,447 |
$385K |
| D1120 |
Prophylaxis - child |
6,713 |
6,464 |
$323K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,963 |
2,304 |
$311K |
| D0220 |
Intraoral - periapical first radiographic image |
18,159 |
16,617 |
$277K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,489 |
8,151 |
$237K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,341 |
13,110 |
$207K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,554 |
1,245 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,599 |
3,407 |
$153K |
| D0140 |
Limited oral evaluation - problem focused |
3,693 |
3,446 |
$135K |
| D1351 |
Sealant - per tooth |
3,087 |
714 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
1,006 |
964 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
856 |
550 |
$67K |
| D2740 |
Crown - porcelain/ceramic |
51 |
38 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
374 |
255 |
$32K |
| D0272 |
Bitewings - two radiographic images |
909 |
822 |
$24K |
| D1206 |
Topical application of fluoride varnish |
708 |
679 |
$17K |
| D0270 |
|
535 |
459 |
$6K |
| D4341 |
|
48 |
18 |
$5K |
| D2330 |
|
84 |
35 |
$5K |
| D2950 |
|
19 |
16 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
12 |
$2K |
| D9110 |
|
68 |
65 |
$2K |
| D2331 |
|
32 |
14 |
$2K |
| D1999 |
|
12,227 |
10,348 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
17 |
14 |
$0.00 |