| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
14,669 |
13,928 |
$773K |
| D0274 |
Bitewings - four radiographic images |
16,650 |
15,868 |
$591K |
| D1120 |
Prophylaxis - child |
11,560 |
10,956 |
$566K |
| D0120 |
Periodic oral evaluation - established patient |
21,421 |
20,490 |
$524K |
| D0220 |
Intraoral - periapical first radiographic image |
31,095 |
28,992 |
$484K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,366 |
14,539 |
$429K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,231 |
2,740 |
$421K |
| D0140 |
Limited oral evaluation - problem focused |
10,427 |
9,837 |
$389K |
| D1351 |
Sealant - per tooth |
9,191 |
2,418 |
$365K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,584 |
21,503 |
$348K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,507 |
6,028 |
$284K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,219 |
2,199 |
$256K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,001 |
1,699 |
$216K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
368 |
228 |
$191K |
| D2740 |
Crown - porcelain/ceramic |
245 |
132 |
$168K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,070 |
670 |
$136K |
| D0272 |
Bitewings - two radiographic images |
3,372 |
3,197 |
$96K |
| D2335 |
|
722 |
372 |
$93K |
| D2950 |
|
464 |
294 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
701 |
453 |
$63K |
| D2394 |
|
403 |
253 |
$50K |
| D2332 |
|
278 |
174 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
419 |
405 |
$29K |
| D4341 |
|
214 |
80 |
$25K |
| D2330 |
|
303 |
143 |
$20K |
| D2331 |
|
97 |
77 |
$8K |
| D9110 |
|
33 |
32 |
$1K |
| D0270 |
|
55 |
55 |
$748.00 |
| D1999 |
|
18,201 |
15,094 |
$0.00 |