| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,153 |
10,089 |
$862K |
| D0120 |
Periodic oral evaluation - established patient |
10,239 |
10,163 |
$567K |
| D0230 |
Intraoral - periapical each additional radiographic image |
128,789 |
17,520 |
$553K |
| D4341 |
|
7,601 |
2,055 |
$527K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
779 |
571 |
$370K |
| D4910 |
|
4,785 |
4,724 |
$368K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,982 |
4,950 |
$310K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,561 |
1,702 |
$297K |
| D0220 |
Intraoral - periapical first radiographic image |
21,387 |
20,905 |
$251K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,940 |
15,838 |
$207K |
| D9430 |
|
5,304 |
5,148 |
$168K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,803 |
1,534 |
$158K |
| D1120 |
Prophylaxis - child |
4,055 |
4,038 |
$147K |
| D2954 |
|
699 |
516 |
$73K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
116 |
113 |
$53K |
| D1351 |
Sealant - per tooth |
1,818 |
439 |
$49K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
281 |
205 |
$19K |
| D2140 |
|
320 |
202 |
$17K |
| D3320 |
|
46 |
39 |
$17K |
| D2160 |
|
80 |
69 |
$6K |
| D0350 |
|
652 |
346 |
$6K |
| D0274 |
Bitewings - four radiographic images |
89 |
89 |
$2K |
| D9110 |
|
26 |
26 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$490.00 |