| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,033 |
4,959 |
$308K |
| D0330 |
Panoramic radiographic image |
3,533 |
3,497 |
$291K |
| D1206 |
Topical application of fluoride varnish |
7,403 |
7,333 |
$233K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,714 |
4,653 |
$215K |
| D0274 |
Bitewings - four radiographic images |
3,984 |
3,929 |
$172K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
835 |
423 |
$161K |
| D1120 |
Prophylaxis - child |
3,656 |
3,635 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
3,902 |
3,863 |
$152K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,342 |
778 |
$133K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,714 |
896 |
$126K |
| D1330 |
|
3,389 |
3,345 |
$90K |
| D0140 |
Limited oral evaluation - problem focused |
2,056 |
1,980 |
$80K |
| D0272 |
Bitewings - two radiographic images |
1,954 |
1,937 |
$69K |
| D4341 |
|
285 |
105 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
566 |
319 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
2,195 |
2,150 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,718 |
1,453 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
221 |
147 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,000 |
847 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
131 |
94 |
$16K |
| D2140 |
|
225 |
108 |
$16K |
| D0240 |
|
436 |
222 |
$15K |
| D1354 |
|
358 |
72 |
$13K |
| D4355 |
|
253 |
251 |
$13K |
| D1351 |
Sealant - per tooth |
292 |
72 |
$8K |
| D2950 |
|
13 |
12 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20 |
14 |
$2K |
| D4910 |
|
14 |
14 |
$1K |