| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,892 |
9,236 |
$397K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,371 |
12,418 |
$336K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,051 |
3,889 |
$229K |
| D0330 |
Panoramic radiographic image |
4,363 |
4,193 |
$217K |
| D9110 |
|
5,936 |
5,374 |
$187K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,594 |
1,971 |
$128K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,912 |
1,821 |
$116K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
284 |
246 |
$113K |
| D1120 |
Prophylaxis - child |
2,378 |
2,179 |
$107K |
| D0272 |
Bitewings - two radiographic images |
6,763 |
6,382 |
$106K |
| D2394 |
|
1,168 |
912 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,616 |
5,187 |
$76K |
| D1351 |
Sealant - per tooth |
3,010 |
556 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,263 |
2,016 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
5,798 |
5,261 |
$46K |
| D2740 |
Crown - porcelain/ceramic |
90 |
38 |
$46K |
| D2750 |
|
76 |
39 |
$44K |
| D2330 |
|
1,140 |
749 |
$43K |
| D3310 |
|
174 |
89 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
423 |
269 |
$38K |
| D2335 |
|
550 |
321 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
580 |
457 |
$38K |
| D3320 |
|
56 |
44 |
$18K |
| D2332 |
|
193 |
134 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
725 |
481 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
144 |
137 |
$4K |
| D2331 |
|
31 |
27 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
14 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
14 |
$281.03 |
| D9986 |
|
45 |
42 |
$123.00 |