| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,880 |
7,309 |
$322K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,493 |
1,145 |
$259K |
| D0120 |
Periodic oral evaluation - established patient |
9,444 |
8,350 |
$226K |
| D0140 |
Limited oral evaluation - problem focused |
8,652 |
7,252 |
$218K |
| D2394 |
|
1,592 |
816 |
$202K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,505 |
6,987 |
$192K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,294 |
3,686 |
$188K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,209 |
1,134 |
$177K |
| D0210 |
Intraoral - complete series of radiographic images |
2,889 |
2,598 |
$164K |
| D1110 |
Prophylaxis - adult |
4,825 |
4,366 |
$144K |
| D0274 |
Bitewings - four radiographic images |
2,713 |
2,485 |
$83K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,600 |
561 |
$81K |
| D3110 |
|
923 |
380 |
$81K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
317 |
138 |
$74K |
| D7250 |
|
731 |
192 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
928 |
365 |
$58K |
| D1351 |
Sealant - per tooth |
1,812 |
367 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
878 |
480 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,871 |
4,331 |
$51K |
| D0330 |
Panoramic radiographic image |
657 |
576 |
$38K |
| D2161 |
|
383 |
245 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,145 |
1,056 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,725 |
1,607 |
$25K |
| D2160 |
|
388 |
200 |
$24K |
| D2335 |
|
171 |
71 |
$17K |
| D2950 |
|
444 |
175 |
$13K |
| D2791 |
|
28 |
26 |
$10K |
| D2954 |
|
97 |
67 |
$9K |
| D2940 |
|
260 |
156 |
$8K |
| D7511 |
|
144 |
121 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
40 |
30 |
$7K |
| D7240 |
Removal of impacted tooth - completely bony |
37 |
12 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
523 |
371 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
85 |
54 |
$4K |
| D2140 |
|
41 |
16 |
$1K |
| D9310 |
|
29 |
26 |
$459.68 |
| D1999 |
|
236 |
185 |
$0.00 |