| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,484 |
10,479 |
$484K |
| D0120 |
Periodic oral evaluation - established patient |
13,881 |
13,879 |
$324K |
| D0274 |
Bitewings - four radiographic images |
12,867 |
12,864 |
$297K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,086 |
2,368 |
$207K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,864 |
2,169 |
$192K |
| D0220 |
Intraoral - periapical first radiographic image |
12,000 |
11,977 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,638 |
1,891 |
$116K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,403 |
13,399 |
$100K |
| D1120 |
Prophylaxis - child |
1,893 |
1,893 |
$65K |
| D2791 |
|
169 |
147 |
$60K |
| D2954 |
|
356 |
323 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,335 |
3,335 |
$37K |
| D9110 |
|
924 |
923 |
$21K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
41 |
31 |
$19K |
| D1351 |
Sealant - per tooth |
451 |
98 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
359 |
253 |
$13K |
| D2160 |
|
137 |
130 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
32 |
32 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
107 |
89 |
$9K |
| D2331 |
|
90 |
74 |
$6K |
| D2140 |
|
67 |
57 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
25 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$649.60 |
| D9310 |
|
15 |
15 |
$450.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$402.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$180.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$164.00 |