| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
14,895 |
4,112 |
$1.02M |
| D1110 |
Prophylaxis - adult |
10,714 |
10,662 |
$922K |
| D4910 |
|
10,030 |
9,993 |
$771K |
| D0120 |
Periodic oral evaluation - established patient |
10,918 |
10,859 |
$630K |
| D0230 |
Intraoral - periapical each additional radiographic image |
41,919 |
17,538 |
$569K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,813 |
5,797 |
$368K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
517 |
440 |
$246K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,710 |
15,639 |
$210K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,502 |
1,087 |
$178K |
| D0272 |
Bitewings - two radiographic images |
13,616 |
13,552 |
$162K |
| D1120 |
Prophylaxis - child |
3,654 |
3,641 |
$139K |
| D1351 |
Sealant - per tooth |
3,783 |
799 |
$108K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,841 |
1,257 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
6,886 |
6,743 |
$81K |
| D9430 |
|
1,287 |
1,252 |
$41K |
| D4342 |
|
943 |
337 |
$37K |
| D5110 |
|
56 |
53 |
$35K |
| D2954 |
|
319 |
275 |
$33K |
| D0330 |
Panoramic radiographic image |
1,162 |
1,160 |
$33K |
| D5750 |
|
162 |
162 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,001 |
994 |
$21K |
| D0350 |
|
1,272 |
1,173 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
257 |
178 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
252 |
250 |
$10K |
| D5120 |
|
13 |
13 |
$8K |
| D2140 |
|
150 |
81 |
$8K |
| D5751 |
|
25 |
25 |
$5K |
| D2330 |
|
52 |
34 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$4K |
| D9110 |
|
38 |
37 |
$2K |