| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,921 |
2,900 |
$240K |
| D0120 |
Periodic oral evaluation - established patient |
4,845 |
4,814 |
$236K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,394 |
2,384 |
$142K |
| D1120 |
Prophylaxis - child |
3,176 |
3,161 |
$119K |
| D0210 |
Intraoral - complete series of radiographic images |
2,477 |
2,465 |
$113K |
| D4341 |
|
1,600 |
434 |
$111K |
| D9110 |
|
1,696 |
1,615 |
$102K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,803 |
1,094 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,694 |
915 |
$91K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
150 |
109 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,014 |
676 |
$67K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
437 |
308 |
$50K |
| D0350 |
|
3,672 |
2,422 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,202 |
2,967 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,407 |
2,311 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,230 |
2,226 |
$27K |
| D2952 |
|
174 |
126 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,732 |
1,729 |
$17K |
| D1351 |
Sealant - per tooth |
668 |
176 |
$16K |
| D2140 |
|
296 |
153 |
$16K |
| D4910 |
|
194 |
194 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
225 |
151 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,306 |
1,305 |
$14K |
| D0330 |
Panoramic radiographic image |
38 |
38 |
$1K |
| D1330 |
|
61 |
61 |
$0.00 |