| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
16,638 |
15,961 |
$897K |
| D0274 |
Bitewings - four radiographic images |
20,015 |
19,196 |
$726K |
| D1120 |
Prophylaxis - child |
13,491 |
12,963 |
$667K |
| D0120 |
Periodic oral evaluation - established patient |
25,437 |
24,456 |
$633K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,025 |
17,301 |
$510K |
| D1351 |
Sealant - per tooth |
11,583 |
2,970 |
$448K |
| D0220 |
Intraoral - periapical first radiographic image |
26,441 |
25,168 |
$431K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,007 |
20,805 |
$345K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,819 |
2,325 |
$311K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,193 |
5,908 |
$273K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,558 |
1,904 |
$237K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,550 |
1,591 |
$216K |
| D0140 |
Limited oral evaluation - problem focused |
4,861 |
4,656 |
$190K |
| D0272 |
Bitewings - two radiographic images |
3,383 |
3,277 |
$98K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
340 |
242 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
500 |
479 |
$32K |
| D2740 |
Crown - porcelain/ceramic |
51 |
39 |
$31K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
23 |
15 |
$11K |
| D2335 |
|
64 |
41 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
90 |
43 |
$8K |
| D2331 |
|
98 |
62 |
$8K |
| D2330 |
|
104 |
50 |
$7K |
| D7111 |
|
95 |
62 |
$7K |
| D2332 |
|
53 |
29 |
$5K |
| D2950 |
|
37 |
26 |
$4K |
| D0270 |
|
12 |
12 |
$180.00 |
| D1999 |
|
14,731 |
12,824 |
$0.00 |