| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,378 |
10,121 |
$576K |
| D0330 |
Panoramic radiographic image |
6,271 |
6,106 |
$397K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,163 |
1,883 |
$346K |
| D2750 |
|
697 |
446 |
$332K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,668 |
1,584 |
$328K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,766 |
5,626 |
$326K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,289 |
13,961 |
$309K |
| D0120 |
Periodic oral evaluation - established patient |
8,910 |
8,710 |
$236K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,772 |
1,161 |
$235K |
| D2394 |
|
1,152 |
833 |
$178K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,862 |
1,094 |
$155K |
| D1120 |
Prophylaxis - child |
3,801 |
3,726 |
$146K |
| D0140 |
Limited oral evaluation - problem focused |
3,023 |
2,916 |
$130K |
| D5212 |
|
181 |
180 |
$113K |
| D2335 |
|
831 |
499 |
$106K |
| D1351 |
Sealant - per tooth |
2,467 |
515 |
$80K |
| D0272 |
Bitewings - two radiographic images |
2,739 |
2,669 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
973 |
517 |
$73K |
| D5211 |
|
108 |
108 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,078 |
2,055 |
$66K |
| D9110 |
|
502 |
490 |
$29K |
| D2332 |
|
205 |
111 |
$22K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
35 |
29 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
180 |
158 |
$16K |
| D4355 |
|
147 |
140 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
826 |
732 |
$10K |
| D9310 |
|
103 |
102 |
$9K |
| D3320 |
|
19 |
12 |
$8K |
| D7250 |
|
24 |
12 |
$5K |
| D2950 |
|
136 |
112 |
$0.00 |