| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,209 |
5,928 |
$276K |
| D0120 |
Periodic oral evaluation - established patient |
8,147 |
7,943 |
$257K |
| D1120 |
Prophylaxis - child |
4,913 |
4,601 |
$197K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,280 |
7,956 |
$180K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,168 |
1,353 |
$123K |
| D0140 |
Limited oral evaluation - problem focused |
2,776 |
2,631 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,556 |
2,444 |
$106K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
216 |
149 |
$98K |
| D1351 |
Sealant - per tooth |
4,450 |
882 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
2,126 |
2,091 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,915 |
1,204 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,866 |
8,101 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
10,444 |
9,716 |
$49K |
| D0274 |
Bitewings - four radiographic images |
3,745 |
3,636 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
431 |
319 |
$31K |
| D9920 |
|
1,835 |
842 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,274 |
2,208 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
227 |
130 |
$16K |
| D0601 |
|
1,320 |
1,202 |
$11K |
| D9110 |
|
633 |
611 |
$10K |
| D0602 |
|
778 |
764 |
$8K |
| D2950 |
|
112 |
77 |
$7K |
| D0603 |
|
382 |
334 |
$3K |
| D0180 |
|
33 |
33 |
$1K |
| D0170 |
|
30 |
28 |
$1K |
| D2331 |
|
17 |
13 |
$1K |
| D0350 |
|
30 |
30 |
$664.00 |