| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,271 |
4,864 |
$214K |
| D0330 |
Panoramic radiographic image |
3,927 |
3,618 |
$212K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,464 |
1,346 |
$212K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,183 |
3,845 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
3,672 |
3,423 |
$78K |
| D0274 |
Bitewings - four radiographic images |
2,924 |
2,716 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,794 |
2,596 |
$52K |
| D2740 |
Crown - porcelain/ceramic |
64 |
51 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
574 |
396 |
$43K |
| D1351 |
Sealant - per tooth |
1,223 |
225 |
$41K |
| D1120 |
Prophylaxis - child |
1,486 |
1,383 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,422 |
1,293 |
$35K |
| D2330 |
|
427 |
177 |
$35K |
| D8030 |
|
288 |
250 |
$20K |
| D2332 |
|
156 |
79 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
318 |
116 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,534 |
2,304 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
117 |
83 |
$11K |
| D2140 |
|
153 |
58 |
$6K |
| D0240 |
|
234 |
88 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
428 |
264 |
$3K |
| D2950 |
|
19 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
143 |
125 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
14 |
$1K |