| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,916 |
4,866 |
$403K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,506 |
4,470 |
$284K |
| D2330 |
|
2,727 |
1,509 |
$208K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,870 |
2,020 |
$190K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,056 |
1,564 |
$171K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,035 |
1,840 |
$163K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,855 |
8,621 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
2,942 |
2,931 |
$146K |
| D0274 |
Bitewings - four radiographic images |
5,083 |
5,048 |
$105K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
195 |
180 |
$90K |
| D1120 |
Prophylaxis - child |
2,552 |
2,537 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,181 |
7,123 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
5,032 |
4,808 |
$59K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
95 |
71 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
567 |
480 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
333 |
211 |
$39K |
| D9430 |
|
1,073 |
1,036 |
$34K |
| D1351 |
Sealant - per tooth |
870 |
209 |
$19K |
| D4341 |
|
266 |
86 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
231 |
149 |
$15K |
| D3320 |
|
28 |
24 |
$10K |
| D2140 |
|
114 |
65 |
$6K |
| D0272 |
Bitewings - two radiographic images |
80 |
80 |
$864.50 |
| D1999 |
|
56 |
51 |
$0.00 |