| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,698 |
9,617 |
$847K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,974 |
10,888 |
$716K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,533 |
4,619 |
$707K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,845 |
3,666 |
$689K |
| D2740 |
Crown - porcelain/ceramic |
1,179 |
672 |
$563K |
| D0210 |
Intraoral - complete series of radiographic images |
8,142 |
8,077 |
$391K |
| D0350 |
|
43,199 |
11,161 |
$389K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,068 |
3,370 |
$385K |
| D4341 |
|
4,848 |
1,340 |
$341K |
| D0120 |
Periodic oral evaluation - established patient |
3,878 |
3,851 |
$310K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,538 |
13,435 |
$200K |
| D9430 |
|
5,836 |
5,340 |
$186K |
| D1120 |
Prophylaxis - child |
3,456 |
3,436 |
$169K |
| D2330 |
|
1,951 |
851 |
$154K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,568 |
1,030 |
$125K |
| D0330 |
Panoramic radiographic image |
4,373 |
4,348 |
$124K |
| D0274 |
Bitewings - four radiographic images |
3,401 |
3,368 |
$71K |
| D2331 |
|
779 |
491 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,033 |
484 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,121 |
5,864 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,651 |
2,518 |
$31K |
| D4910 |
|
356 |
356 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,301 |
2,290 |
$26K |
| D1351 |
Sealant - per tooth |
656 |
140 |
$23K |
| D4342 |
|
217 |
69 |
$9K |
| D3310 |
|
23 |
12 |
$7K |
| D7230 |
|
35 |
29 |
$7K |
| D1320 |
|
42 |
42 |
$735.00 |