| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,084 |
5,023 |
$313K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,145 |
2,908 |
$214K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,989 |
4,920 |
$208K |
| D2740 |
Crown - porcelain/ceramic |
453 |
376 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
4,780 |
4,731 |
$163K |
| D1206 |
Topical application of fluoride varnish |
6,448 |
6,397 |
$146K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,280 |
1,152 |
$141K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,727 |
1,755 |
$114K |
| D1120 |
Prophylaxis - child |
2,685 |
2,654 |
$92K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,338 |
1,050 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
10,546 |
10,292 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
2,267 |
2,235 |
$62K |
| D9430 |
|
3,311 |
3,219 |
$61K |
| D0274 |
Bitewings - four radiographic images |
5,296 |
5,234 |
$56K |
| D1351 |
Sealant - per tooth |
1,497 |
377 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
458 |
241 |
$29K |
| D1310 |
|
910 |
897 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,288 |
6,842 |
$24K |
| D2330 |
|
328 |
209 |
$18K |
| D2331 |
|
177 |
136 |
$11K |
| D1320 |
|
1,519 |
1,518 |
$11K |
| D4341 |
|
230 |
94 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
159 |
78 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
1,080 |
1,040 |
$5K |
| D0330 |
Panoramic radiographic image |
244 |
244 |
$5K |
| D0603 |
|
442 |
402 |
$2K |
| D1999 |
|
146 |
143 |
$2K |
| D0272 |
Bitewings - two radiographic images |
132 |
130 |
$1K |
| D0601 |
|
81 |
74 |
$326.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
22 |
20 |
$297.00 |
| D0270 |
|
15 |
15 |
$35.00 |
| D9993 |
|
521 |
508 |
$0.00 |
| D1330 |
|
1,983 |
1,916 |
$0.00 |
| D7250 |
|
27 |
12 |
$0.00 |