| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,401 |
6,888 |
$388K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
560 |
489 |
$376K |
| D2740 |
Crown - porcelain/ceramic |
571 |
394 |
$369K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,337 |
2,165 |
$267K |
| D0120 |
Periodic oral evaluation - established patient |
9,125 |
8,526 |
$214K |
| D1120 |
Prophylaxis - child |
4,055 |
3,751 |
$194K |
| D0274 |
Bitewings - four radiographic images |
4,829 |
4,433 |
$169K |
| D1206 |
Topical application of fluoride varnish |
5,019 |
4,643 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,648 |
985 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
6,071 |
5,405 |
$90K |
| D0140 |
Limited oral evaluation - problem focused |
2,056 |
1,844 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,053 |
976 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
675 |
485 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,359 |
1,261 |
$57K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
88 |
72 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,345 |
2,705 |
$40K |
| D0272 |
Bitewings - two radiographic images |
758 |
732 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
185 |
107 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
648 |
623 |
$19K |
| D2950 |
|
93 |
67 |
$14K |
| D0330 |
Panoramic radiographic image |
179 |
173 |
$13K |
| D2335 |
|
93 |
39 |
$9K |
| D1351 |
Sealant - per tooth |
206 |
53 |
$8K |
| D2332 |
|
88 |
57 |
$7K |
| D2330 |
|
40 |
25 |
$2K |
| D2331 |
|
26 |
12 |
$2K |
| D9995 |
|
22 |
17 |
$0.00 |
| D1999 |
|
502 |
415 |
$0.00 |