| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,695 |
8,950 |
$385K |
| D0120 |
Periodic oral evaluation - established patient |
11,380 |
9,397 |
$279K |
| D4341 |
|
1,503 |
709 |
$223K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,219 |
7,678 |
$209K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,539 |
1,787 |
$146K |
| D1351 |
Sealant - per tooth |
1,715 |
1,000 |
$115K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,683 |
1,077 |
$108K |
| D1110 |
Prophylaxis - adult |
2,774 |
2,494 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,068 |
4,488 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,650 |
1,153 |
$66K |
| D0274 |
Bitewings - four radiographic images |
4,296 |
3,582 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,074 |
742 |
$54K |
| D0330 |
Panoramic radiographic image |
2,674 |
2,284 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
3,040 |
2,594 |
$46K |
| D9110 |
|
910 |
729 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
630 |
481 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
8,014 |
6,655 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
463 |
306 |
$28K |
| D0272 |
Bitewings - two radiographic images |
3,295 |
2,830 |
$28K |
| D2750 |
|
97 |
66 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,973 |
4,977 |
$19K |
| D8670 |
Periodic orthodontic treatment visit |
139 |
131 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
1,523 |
1,167 |
$15K |
| D2160 |
|
178 |
127 |
$12K |
| D4910 |
|
187 |
169 |
$11K |
| D2950 |
|
159 |
107 |
$8K |
| D0270 |
|
1,265 |
1,059 |
$6K |
| D2331 |
|
105 |
75 |
$5K |
| D9310 |
|
309 |
266 |
$5K |
| D2740 |
Crown - porcelain/ceramic |
14 |
13 |
$4K |
| D8999 |
|
135 |
115 |
$4K |
| D2330 |
|
65 |
48 |
$3K |
| D7240 |
Removal of impacted tooth - completely bony |
22 |
16 |
$2K |
| D2332 |
|
27 |
17 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
46 |
46 |
$1K |
| D1999 |
|
262 |
252 |
$0.00 |