| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,816 |
6,544 |
$308K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,153 |
2,455 |
$268K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,587 |
1,157 |
$172K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,282 |
1,449 |
$164K |
| D0274 |
Bitewings - four radiographic images |
5,581 |
5,358 |
$151K |
| D0330 |
Panoramic radiographic image |
3,535 |
3,417 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,863 |
4,673 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
5,619 |
5,391 |
$123K |
| D0140 |
Limited oral evaluation - problem focused |
3,385 |
3,269 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,599 |
1,041 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,963 |
735 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,249 |
1,152 |
$68K |
| D1120 |
Prophylaxis - child |
1,296 |
1,269 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
6,322 |
5,968 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,435 |
3,662 |
$49K |
| D2740 |
Crown - porcelain/ceramic |
76 |
50 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,183 |
2,081 |
$41K |
| D2394 |
|
503 |
331 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,452 |
2,375 |
$37K |
| D2335 |
|
240 |
118 |
$21K |
| D2332 |
|
127 |
72 |
$10K |
| D1351 |
Sealant - per tooth |
107 |
26 |
$2K |
| D0431 |
|
23 |
21 |
$170.00 |