| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
13,842 |
13,808 |
$628K |
| D0120 |
Periodic oral evaluation - established patient |
21,022 |
20,971 |
$478K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,872 |
19,816 |
$336K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,299 |
3,423 |
$325K |
| D0274 |
Bitewings - four radiographic images |
14,501 |
14,482 |
$320K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,030 |
4,118 |
$261K |
| D1120 |
Prophylaxis - child |
6,505 |
6,498 |
$222K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,416 |
2,560 |
$193K |
| D0220 |
Intraoral - periapical first radiographic image |
13,838 |
13,629 |
$150K |
| D1351 |
Sealant - per tooth |
2,514 |
1,247 |
$143K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
304 |
258 |
$142K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,814 |
9,800 |
$101K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,281 |
1,124 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
5,035 |
4,881 |
$56K |
| D2394 |
|
529 |
495 |
$56K |
| D3320 |
|
151 |
151 |
$53K |
| D0272 |
Bitewings - two radiographic images |
3,526 |
3,523 |
$46K |
| D2335 |
|
333 |
317 |
$46K |
| D4341 |
|
655 |
418 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
499 |
475 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
3,109 |
3,088 |
$35K |
| D2330 |
|
438 |
372 |
$27K |
| D2954 |
|
216 |
210 |
$27K |
| D0240 |
|
1,243 |
1,207 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,040 |
1,037 |
$25K |
| D2791 |
|
39 |
37 |
$21K |
| D2952 |
|
174 |
168 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
170 |
142 |
$18K |
| D2332 |
|
172 |
164 |
$16K |
| D3310 |
|
37 |
36 |
$13K |
| D1354 |
|
483 |
126 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
70 |
65 |
$5K |
| D9110 |
|
304 |
298 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
191 |
191 |
$5K |
| D2331 |
|
27 |
27 |
$2K |
| D1999 |
|
176 |
141 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
175 |
140 |
$0.00 |