| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,452 |
6,315 |
$287K |
| D2740 |
Crown - porcelain/ceramic |
565 |
416 |
$286K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,360 |
2,014 |
$216K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
396 |
274 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
8,184 |
8,036 |
$144K |
| D0210 |
Intraoral - complete series of radiographic images |
2,643 |
2,597 |
$127K |
| D2950 |
|
875 |
623 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,465 |
843 |
$84K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
997 |
708 |
$81K |
| D0274 |
Bitewings - four radiographic images |
3,768 |
3,691 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
7,625 |
7,326 |
$68K |
| D1120 |
Prophylaxis - child |
2,368 |
2,337 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,376 |
2,339 |
$62K |
| D1206 |
Topical application of fluoride varnish |
3,466 |
3,415 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,697 |
1,642 |
$23K |
| D1351 |
Sealant - per tooth |
1,092 |
151 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,839 |
4,411 |
$19K |
| D2954 |
|
117 |
88 |
$16K |
| D2335 |
|
76 |
40 |
$8K |
| D0330 |
Panoramic radiographic image |
151 |
151 |
$6K |
| D2332 |
|
51 |
28 |
$4K |
| D2330 |
|
61 |
33 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
222 |
222 |
$3K |
| D9920 |
|
129 |
129 |
$2K |
| D0270 |
|
188 |
184 |
$2K |
| D1320 |
|
149 |
149 |
$1K |
| D0603 |
|
139 |
139 |
$1K |
| D2394 |
|
15 |
12 |
$1K |
| D0602 |
|
118 |
118 |
$1K |
| D0601 |
|
106 |
105 |
$1K |
| D2331 |
|
12 |
12 |
$780.00 |
| D0272 |
Bitewings - two radiographic images |
55 |
55 |
$660.00 |
| D4355 |
|
12 |
12 |
$540.00 |
| D4346 |
|
14 |
14 |
$490.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
19 |
$345.00 |
| D1330 |
|
24 |
21 |
$0.00 |
| D1999 |
|
15 |
15 |
$0.00 |