| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,898 |
3,890 |
$328K |
| D0120 |
Periodic oral evaluation - established patient |
4,652 |
4,631 |
$250K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,915 |
2,909 |
$178K |
| D0210 |
Intraoral - complete series of radiographic images |
3,013 |
3,010 |
$139K |
| D9110 |
|
1,899 |
1,474 |
$119K |
| D1120 |
Prophylaxis - child |
2,784 |
2,776 |
$108K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,291 |
740 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,195 |
615 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
804 |
516 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,473 |
3,459 |
$47K |
| D2740 |
Crown - porcelain/ceramic |
76 |
54 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,264 |
2,015 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,686 |
1,686 |
$24K |
| D9430 |
|
592 |
539 |
$19K |
| D0350 |
|
1,471 |
893 |
$14K |
| D4910 |
|
158 |
158 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
988 |
967 |
$12K |
| D2330 |
|
139 |
57 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$6K |
| D2140 |
|
116 |
55 |
$6K |
| D0272 |
Bitewings - two radiographic images |
571 |
569 |
$6K |
| D2954 |
|
55 |
38 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
72 |
41 |
$5K |
| D2952 |
|
39 |
29 |
$4K |
| D0274 |
Bitewings - four radiographic images |
91 |
91 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$1K |