| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
68,265 |
65,972 |
$3.56M |
| D2740 |
Crown - porcelain/ceramic |
3,404 |
1,907 |
$2.29M |
| D0274 |
Bitewings - four radiographic images |
55,172 |
53,680 |
$2.01M |
| D0120 |
Periodic oral evaluation - established patient |
78,453 |
76,440 |
$1.90M |
| D1120 |
Prophylaxis - child |
36,195 |
35,447 |
$1.77M |
| D0210 |
Intraoral - complete series of radiographic images |
22,781 |
21,889 |
$1.58M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,788 |
10,558 |
$1.42M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32,171 |
30,962 |
$1.36M |
| D0140 |
Limited oral evaluation - problem focused |
31,366 |
29,871 |
$1.20M |
| D8670 |
Periodic orthodontic treatment visit |
5,658 |
5,247 |
$1.19M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14,437 |
7,788 |
$893K |
| D1208 |
Topical application of fluoride, excluding varnish |
29,612 |
28,965 |
$835K |
| D0220 |
Intraoral - periapical first radiographic image |
53,510 |
50,913 |
$831K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,171 |
3,272 |
$827K |
| D1351 |
Sealant - per tooth |
17,443 |
4,404 |
$678K |
| D1206 |
Topical application of fluoride varnish |
17,219 |
16,878 |
$462K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
408 |
388 |
$435K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,568 |
2,589 |
$385K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,199 |
26,213 |
$382K |
| D2335 |
|
1,956 |
776 |
$261K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
367 |
250 |
$202K |
| D2950 |
|
1,123 |
733 |
$174K |
| D7311 |
|
1,376 |
1,138 |
$148K |
| D4342 |
|
1,833 |
634 |
$146K |
| D0272 |
Bitewings - two radiographic images |
4,647 |
4,565 |
$138K |
| D4341 |
|
948 |
349 |
$110K |
| D0330 |
Panoramic radiographic image |
1,806 |
1,704 |
$106K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
804 |
573 |
$65K |
| D6010 |
|
40 |
13 |
$60K |
| D8690 |
|
452 |
443 |
$58K |
| D7240 |
Removal of impacted tooth - completely bony |
151 |
52 |
$42K |
| D8680 |
|
318 |
283 |
$28K |
| D2332 |
|
244 |
91 |
$26K |
| D2394 |
|
245 |
144 |
$26K |
| D2330 |
|
405 |
190 |
$24K |
| D2954 |
|
104 |
79 |
$20K |
| D8660 |
|
720 |
696 |
$19K |
| D0270 |
|
1,516 |
1,441 |
$19K |
| D9310 |
|
283 |
262 |
$15K |
| D2331 |
|
133 |
66 |
$11K |
| D7950 |
|
13 |
13 |
$10K |
| D3320 |
|
17 |
12 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
121 |
73 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
14 |
$8K |
| D5212 |
|
12 |
12 |
$7K |
| D7250 |
|
22 |
12 |
$3K |
| D2140 |
|
31 |
14 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
127 |
112 |
$2K |
| D8999 |
|
16 |
14 |
$702.00 |
| D1330 |
|
568 |
554 |
$576.80 |
| D0180 |
|
15 |
13 |
$544.00 |
| D9110 |
|
13 |
13 |
$468.00 |