| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
11,001 |
10,870 |
$676K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,871 |
4,247 |
$632K |
| D0120 |
Periodic oral evaluation - established patient |
12,525 |
12,389 |
$520K |
| D1206 |
Topical application of fluoride varnish |
13,705 |
13,546 |
$454K |
| D0330 |
Panoramic radiographic image |
5,091 |
5,008 |
$436K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,741 |
1,542 |
$387K |
| D0274 |
Bitewings - four radiographic images |
8,584 |
8,467 |
$384K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,144 |
3,223 |
$382K |
| D1120 |
Prophylaxis - child |
6,691 |
6,630 |
$282K |
| D0140 |
Limited oral evaluation - problem focused |
6,009 |
5,804 |
$265K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,018 |
1,572 |
$219K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,267 |
4,196 |
$184K |
| D0272 |
Bitewings - two radiographic images |
3,582 |
3,545 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
6,076 |
5,900 |
$104K |
| D2331 |
|
896 |
554 |
$92K |
| D2330 |
|
542 |
350 |
$44K |
| D1351 |
Sealant - per tooth |
907 |
244 |
$41K |
| D1330 |
|
991 |
984 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,786 |
1,755 |
$34K |
| D2332 |
|
273 |
177 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
300 |
198 |
$27K |
| D0240 |
|
526 |
272 |
$18K |
| D2335 |
|
99 |
77 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,293 |
810 |
$15K |
| D5110 |
|
13 |
13 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
70 |
58 |
$9K |
| D2160 |
|
35 |
25 |
$4K |
| D2140 |
|
29 |
25 |
$2K |
| D4355 |
|
53 |
51 |
$1K |
| D9995 |
|
111 |
103 |
$0.00 |
| D2394 |
|
19 |
16 |
$0.00 |