| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,126 |
10,109 |
$485K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
646 |
509 |
$370K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,044 |
3,160 |
$305K |
| D0120 |
Periodic oral evaluation - established patient |
11,096 |
11,073 |
$284K |
| D0274 |
Bitewings - four radiographic images |
7,523 |
7,511 |
$189K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,477 |
1,264 |
$182K |
| D0210 |
Intraoral - complete series of radiographic images |
3,597 |
3,585 |
$165K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,621 |
1,373 |
$146K |
| D2954 |
|
921 |
798 |
$128K |
| D2752 |
|
167 |
142 |
$99K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,087 |
968 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,681 |
1,410 |
$88K |
| D1120 |
Prophylaxis - child |
1,922 |
1,921 |
$81K |
| D4341 |
|
1,628 |
698 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,926 |
2,926 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
2,982 |
2,954 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,858 |
2,824 |
$28K |
| D0330 |
Panoramic radiographic image |
523 |
521 |
$16K |
| D2335 |
|
107 |
83 |
$12K |
| D2332 |
|
89 |
70 |
$8K |
| D2394 |
|
64 |
57 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
15 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
221 |
221 |
$7K |
| D3320 |
|
16 |
13 |
$5K |
| D3310 |
|
17 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
453 |
436 |
$3K |
| D2330 |
|
42 |
39 |
$3K |
| D2331 |
|
36 |
25 |
$2K |
| D1351 |
Sealant - per tooth |
29 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$166.89 |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$90.00 |