| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,871 |
3,853 |
$325K |
| D0120 |
Periodic oral evaluation - established patient |
5,987 |
5,968 |
$319K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
592 |
359 |
$281K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,425 |
4,416 |
$278K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,974 |
2,028 |
$266K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,376 |
1,772 |
$224K |
| D4341 |
|
3,157 |
969 |
$220K |
| D1120 |
Prophylaxis - child |
5,720 |
5,662 |
$212K |
| D0210 |
Intraoral - complete series of radiographic images |
4,339 |
4,333 |
$199K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,339 |
782 |
$153K |
| D1351 |
Sealant - per tooth |
5,258 |
1,174 |
$138K |
| D1206 |
Topical application of fluoride varnish |
9,079 |
9,053 |
$127K |
| D4910 |
|
1,629 |
1,620 |
$123K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,265 |
4,400 |
$81K |
| D0330 |
Panoramic radiographic image |
1,753 |
1,752 |
$49K |
| D2330 |
|
513 |
283 |
$39K |
| D0272 |
Bitewings - two radiographic images |
3,210 |
3,199 |
$37K |
| D9430 |
|
1,147 |
1,112 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
424 |
297 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
566 |
327 |
$32K |
| D0350 |
|
3,821 |
1,813 |
$31K |
| D1310 |
|
535 |
534 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,228 |
1,199 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
206 |
116 |
$13K |
| D4342 |
|
234 |
90 |
$10K |
| D9993 |
|
214 |
212 |
$9K |
| D2954 |
|
79 |
54 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
391 |
391 |
$6K |
| D2160 |
|
72 |
55 |
$5K |
| D0603 |
|
162 |
158 |
$2K |
| D2140 |
|
25 |
13 |
$1K |
| D1352 |
|
56 |
17 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$1K |
| D0601 |
|
27 |
27 |
$375.00 |