| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
28,361 |
27,539 |
$1.51M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,266 |
8,460 |
$1.44M |
| D0274 |
Bitewings - four radiographic images |
30,628 |
29,596 |
$1.08M |
| D0120 |
Periodic oral evaluation - established patient |
37,548 |
36,406 |
$899K |
| D1120 |
Prophylaxis - child |
15,764 |
15,189 |
$786K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,235 |
5,717 |
$765K |
| D0220 |
Intraoral - periapical first radiographic image |
43,458 |
41,625 |
$692K |
| D1351 |
Sealant - per tooth |
15,928 |
4,437 |
$628K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,294 |
20,569 |
$609K |
| D0230 |
Intraoral - periapical each additional radiographic image |
53,080 |
34,950 |
$590K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,640 |
4,757 |
$564K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,871 |
9,528 |
$441K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,759 |
2,481 |
$359K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,158 |
1,616 |
$302K |
| D0140 |
Limited oral evaluation - problem focused |
7,560 |
7,338 |
$296K |
| D0210 |
Intraoral - complete series of radiographic images |
4,238 |
4,089 |
$289K |
| D0272 |
Bitewings - two radiographic images |
5,801 |
5,680 |
$171K |
| D2335 |
|
1,073 |
677 |
$154K |
| D2332 |
|
1,089 |
676 |
$123K |
| D2331 |
|
1,202 |
756 |
$103K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
918 |
512 |
$80K |
| D5211 |
|
129 |
127 |
$68K |
| D5212 |
|
107 |
107 |
$61K |
| D2330 |
|
639 |
354 |
$46K |
| D2950 |
|
234 |
190 |
$38K |
| D4341 |
|
307 |
118 |
$37K |
| D4342 |
|
277 |
124 |
$23K |
| D2394 |
|
122 |
100 |
$15K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
13 |
$10K |
| D2160 |
|
44 |
31 |
$4K |
| D2954 |
|
18 |
16 |
$4K |
| D0270 |
|
119 |
118 |
$2K |
| D2140 |
|
25 |
14 |
$1K |
| D0273 |
|
30 |
30 |
$906.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
12 |
$336.00 |
| D1999 |
|
25,463 |
21,144 |
$0.00 |
| D5421 |
|
12 |
12 |
$0.00 |
| D5422 |
|
12 |
12 |
$0.00 |