| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,793 |
2,747 |
$231K |
| D0120 |
Periodic oral evaluation - established patient |
5,553 |
5,422 |
$219K |
| D2740 |
Crown - porcelain/ceramic |
402 |
315 |
$191K |
| D4910 |
|
1,306 |
1,261 |
$167K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,320 |
1,744 |
$155K |
| D1120 |
Prophylaxis - child |
3,904 |
3,791 |
$147K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,775 |
2,717 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,671 |
1,711 |
$145K |
| D1206 |
Topical application of fluoride varnish |
4,059 |
4,052 |
$120K |
| D0274 |
Bitewings - four radiographic images |
4,636 |
4,547 |
$95K |
| D1351 |
Sealant - per tooth |
2,427 |
567 |
$86K |
| D9430 |
|
2,831 |
2,519 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
7,527 |
7,157 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,763 |
1,728 |
$79K |
| D4341 |
|
1,263 |
497 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,492 |
3,316 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,674 |
5,398 |
$60K |
| D1310 |
|
1,986 |
1,935 |
$49K |
| D2954 |
|
268 |
218 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
329 |
228 |
$19K |
| D0270 |
|
2,212 |
1,978 |
$10K |
| D0603 |
|
1,342 |
1,316 |
$9K |
| D4342 |
|
203 |
98 |
$9K |
| D0330 |
Panoramic radiographic image |
257 |
256 |
$8K |
| D0999 |
Unspecified diagnostic procedure, by report |
91 |
91 |
$5K |
| D0601 |
|
635 |
632 |
$5K |
| D2330 |
|
68 |
40 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
29 |
29 |
$3K |
| D1999 |
|
34 |
34 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
13 |
$2K |
| D0350 |
|
303 |
139 |
$2K |
| D0160 |
|
34 |
29 |
$1K |
| D9910 |
|
66 |
45 |
$1K |
| D0602 |
|
126 |
126 |
$175.00 |
| D9993 |
|
1,237 |
1,198 |
$15.00 |
| D1330 |
|
959 |
907 |
$0.00 |