| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,379 |
6,992 |
$296K |
| D1351 |
Sealant - per tooth |
3,627 |
2,077 |
$271K |
| D0120 |
Periodic oral evaluation - established patient |
9,076 |
8,479 |
$247K |
| D4341 |
|
1,528 |
884 |
$228K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,451 |
1,647 |
$211K |
| D4342 |
|
1,677 |
1,110 |
$184K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,051 |
6,638 |
$179K |
| D0274 |
Bitewings - four radiographic images |
8,492 |
8,005 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,449 |
2,060 |
$138K |
| D1110 |
Prophylaxis - adult |
3,326 |
3,198 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,341 |
6,031 |
$135K |
| D9110 |
|
1,966 |
1,814 |
$105K |
| D0330 |
Panoramic radiographic image |
3,889 |
3,661 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,100 |
950 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,055 |
724 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,226 |
1,046 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,037 |
5,552 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
7,735 |
7,262 |
$43K |
| D2332 |
|
517 |
442 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,467 |
2,324 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
373 |
318 |
$21K |
| D2335 |
|
282 |
240 |
$19K |
| D5110 |
|
43 |
43 |
$15K |
| D9630 |
|
488 |
425 |
$9K |
| D2331 |
|
110 |
91 |
$7K |
| D4910 |
|
94 |
93 |
$6K |
| D2740 |
Crown - porcelain/ceramic |
24 |
24 |
$6K |
| D5120 |
|
13 |
13 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
246 |
234 |
$4K |
| D2950 |
|
44 |
39 |
$2K |
| D2140 |
|
33 |
27 |
$1K |
| D2330 |
|
19 |
17 |
$795.80 |
| D2394 |
|
14 |
12 |
$754.65 |
| D1999 |
|
1,661 |
1,301 |
$0.00 |