| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
32,078 |
32,071 |
$1.47M |
| D0120 |
Periodic oral evaluation - established patient |
34,347 |
34,342 |
$784K |
| D0274 |
Bitewings - four radiographic images |
22,296 |
22,292 |
$492K |
| D0210 |
Intraoral - complete series of radiographic images |
8,059 |
8,010 |
$336K |
| D0220 |
Intraoral - periapical first radiographic image |
29,270 |
29,161 |
$317K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
559 |
451 |
$277K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,048 |
3,448 |
$260K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,979 |
2,182 |
$207K |
| D7240 |
Removal of impacted tooth - completely bony |
658 |
607 |
$147K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,995 |
24,972 |
$146K |
| D4341 |
|
2,365 |
1,085 |
$145K |
| D2140 |
|
1,533 |
1,061 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,483 |
1,119 |
$68K |
| D2954 |
|
535 |
452 |
$57K |
| D0330 |
Panoramic radiographic image |
1,153 |
1,152 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
390 |
335 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
430 |
314 |
$23K |
| D2331 |
|
267 |
175 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
1,311 |
1,310 |
$15K |
| D1120 |
Prophylaxis - child |
432 |
432 |
$15K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
34 |
29 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
483 |
483 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
95 |
77 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
563 |
563 |
$6K |
| D2330 |
|
45 |
26 |
$2K |
| D9310 |
|
12 |
12 |
$635.40 |
| D0272 |
Bitewings - two radiographic images |
42 |
42 |
$553.60 |
| D1320 |
|
14 |
14 |
$104.00 |