| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,850 |
5,403 |
$281K |
| D0120 |
Periodic oral evaluation - established patient |
7,615 |
7,155 |
$175K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,894 |
1,006 |
$145K |
| D1120 |
Prophylaxis - child |
2,808 |
2,710 |
$133K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,909 |
3,732 |
$108K |
| D0274 |
Bitewings - four radiographic images |
3,199 |
2,933 |
$108K |
| D0220 |
Intraoral - periapical first radiographic image |
5,329 |
4,947 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,137 |
516 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
958 |
904 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,533 |
1,433 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,051 |
3,429 |
$53K |
| D1351 |
Sealant - per tooth |
1,195 |
329 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
918 |
871 |
$38K |
| D2740 |
Crown - porcelain/ceramic |
53 |
39 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
246 |
160 |
$23K |
| D2950 |
|
121 |
92 |
$19K |
| D9941 |
|
205 |
186 |
$15K |
| D9110 |
|
244 |
233 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
14 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
37 |
$5K |
| D2330 |
|
69 |
28 |
$5K |
| D4341 |
|
32 |
12 |
$4K |
| D3120 |
|
116 |
78 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
13 |
$4K |
| D0272 |
Bitewings - two radiographic images |
126 |
120 |
$4K |
| D4346 |
|
13 |
13 |
$660.00 |