| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,352 |
5,344 |
$405K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,216 |
2,870 |
$350K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,671 |
4,661 |
$243K |
| D2740 |
Crown - porcelain/ceramic |
434 |
352 |
$206K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,333 |
1,843 |
$182K |
| D0364 |
|
614 |
602 |
$152K |
| D0120 |
Periodic oral evaluation - established patient |
3,647 |
3,643 |
$141K |
| D4341 |
|
1,942 |
687 |
$141K |
| D0274 |
Bitewings - four radiographic images |
5,842 |
5,833 |
$131K |
| D9430 |
|
3,515 |
3,186 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,810 |
7,799 |
$93K |
| D0350 |
|
10,342 |
4,483 |
$89K |
| D0330 |
Panoramic radiographic image |
2,330 |
2,328 |
$78K |
| D1120 |
Prophylaxis - child |
2,077 |
2,074 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,628 |
1,624 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
923 |
689 |
$74K |
| D9910 |
|
1,437 |
1,244 |
$58K |
| D2950 |
|
343 |
278 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,717 |
3,932 |
$32K |
| D0170 |
|
319 |
295 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,339 |
2,277 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
179 |
116 |
$21K |
| D2330 |
|
168 |
93 |
$14K |
| D4910 |
|
162 |
162 |
$13K |
| D2331 |
|
91 |
63 |
$9K |
| D4355 |
|
66 |
66 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
61 |
$6K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$144.00 |