| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
11,858 |
11,857 |
$542K |
| D0120 |
Periodic oral evaluation - established patient |
15,083 |
15,079 |
$346K |
| D1120 |
Prophylaxis - child |
5,620 |
5,617 |
$192K |
| D0272 |
Bitewings - two radiographic images |
14,817 |
14,813 |
$191K |
| D0220 |
Intraoral - periapical first radiographic image |
16,516 |
16,496 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,240 |
1,918 |
$155K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,435 |
1,932 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,835 |
1,434 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,775 |
14,774 |
$79K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
133 |
126 |
$68K |
| D0330 |
Panoramic radiographic image |
2,197 |
2,195 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,712 |
2,711 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,087 |
5,085 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
606 |
569 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,424 |
1,423 |
$34K |
| D4341 |
|
392 |
221 |
$27K |
| D1351 |
Sealant - per tooth |
234 |
125 |
$16K |
| D2331 |
|
183 |
175 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
1,453 |
1,452 |
$13K |
| D7111 |
|
263 |
246 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
68 |
$5K |
| D9110 |
|
296 |
295 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
430 |
430 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
32 |
29 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
30 |
26 |
$2K |
| D2954 |
|
13 |
12 |
$2K |
| D2330 |
|
29 |
27 |
$1K |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$578.18 |