| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,471 |
6,416 |
$251K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,468 |
864 |
$161K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,023 |
1,326 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
6,331 |
6,282 |
$140K |
| D0274 |
Bitewings - four radiographic images |
3,880 |
3,847 |
$119K |
| D4346 |
|
2,559 |
2,524 |
$105K |
| D0330 |
Panoramic radiographic image |
2,381 |
2,352 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,842 |
4,181 |
$89K |
| D1120 |
Prophylaxis - child |
2,119 |
2,108 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
839 |
605 |
$64K |
| D1330 |
|
5,625 |
5,560 |
$64K |
| D1310 |
|
5,668 |
5,603 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,199 |
1,178 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,499 |
2,470 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,576 |
2,555 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
929 |
688 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
5,998 |
5,885 |
$52K |
| D1206 |
Topical application of fluoride varnish |
885 |
882 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,034 |
1,021 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
188 |
139 |
$11K |
| D2332 |
|
136 |
93 |
$9K |
| D9110 |
|
318 |
315 |
$9K |
| D1320 |
|
509 |
506 |
$9K |
| D1351 |
Sealant - per tooth |
369 |
129 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
134 |
133 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
129 |
127 |
$6K |
| D2331 |
|
68 |
54 |
$5K |
| D2140 |
|
86 |
60 |
$4K |
| D0270 |
|
329 |
322 |
$3K |
| D2160 |
|
40 |
36 |
$3K |
| D2330 |
|
35 |
24 |
$2K |
| D2335 |
|
26 |
17 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14 |
12 |
$1K |
| D2394 |
|
13 |
12 |
$1K |
| D0240 |
|
78 |
62 |
$966.00 |
| D1354 |
|
94 |
30 |
$807.50 |