| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,770 |
5,561 |
$312K |
| D1120 |
Prophylaxis - child |
4,692 |
4,585 |
$237K |
| D2740 |
Crown - porcelain/ceramic |
327 |
240 |
$215K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,727 |
1,468 |
$208K |
| D0274 |
Bitewings - four radiographic images |
5,338 |
5,179 |
$197K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,116 |
3,948 |
$189K |
| D0120 |
Periodic oral evaluation - established patient |
7,013 |
6,842 |
$179K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,622 |
5,475 |
$163K |
| D0220 |
Intraoral - periapical first radiographic image |
9,137 |
8,676 |
$151K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,450 |
709 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,866 |
6,574 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
1,443 |
1,371 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,504 |
884 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
2,268 |
2,151 |
$86K |
| D1351 |
Sealant - per tooth |
2,013 |
538 |
$82K |
| D2950 |
|
247 |
200 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,016 |
979 |
$29K |
| D1206 |
Topical application of fluoride varnish |
448 |
448 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
66 |
45 |
$10K |
| D2331 |
|
99 |
52 |
$7K |
| D2330 |
|
95 |
54 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
43 |
$5K |
| D0270 |
|
235 |
226 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
12 |
$2K |
| D1999 |
|
6,397 |
5,310 |
$0.00 |