| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
14,062 |
13,943 |
$723K |
| D0210 |
Intraoral - complete series of radiographic images |
7,812 |
7,738 |
$555K |
| D2740 |
Crown - porcelain/ceramic |
737 |
567 |
$532K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,807 |
2,360 |
$520K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,280 |
3,178 |
$373K |
| D0120 |
Periodic oral evaluation - established patient |
16,393 |
16,263 |
$352K |
| D0274 |
Bitewings - four radiographic images |
5,886 |
5,846 |
$205K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
287 |
276 |
$192K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,751 |
3,716 |
$153K |
| D2954 |
|
636 |
500 |
$120K |
| D0220 |
Intraoral - periapical first radiographic image |
7,783 |
7,521 |
$114K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,559 |
3,540 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,207 |
874 |
$101K |
| D9110 |
|
2,492 |
2,472 |
$96K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,158 |
835 |
$88K |
| D3320 |
|
168 |
138 |
$87K |
| D1120 |
Prophylaxis - child |
1,211 |
1,200 |
$61K |
| D4341 |
|
345 |
135 |
$45K |
| D5212 |
|
50 |
50 |
$27K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
50 |
45 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
368 |
252 |
$24K |
| D0272 |
Bitewings - two radiographic images |
792 |
784 |
$21K |
| D5211 |
|
38 |
37 |
$18K |
| D3310 |
|
36 |
25 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,291 |
1,147 |
$16K |
| D2140 |
|
231 |
167 |
$15K |
| D5110 |
|
12 |
12 |
$9K |
| D2160 |
|
83 |
71 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
39 |
$4K |
| D2335 |
|
14 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
24 |
$1K |
| D0270 |
|
38 |
38 |
$531.00 |