| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,403 |
10,031 |
$551K |
| D2740 |
Crown - porcelain/ceramic |
624 |
472 |
$427K |
| D0274 |
Bitewings - four radiographic images |
8,008 |
7,751 |
$280K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,239 |
6,089 |
$279K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,374 |
2,121 |
$271K |
| D0120 |
Periodic oral evaluation - established patient |
9,097 |
8,792 |
$219K |
| D1120 |
Prophylaxis - child |
4,101 |
4,028 |
$205K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,832 |
5,739 |
$170K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,445 |
1,439 |
$159K |
| D0210 |
Intraoral - complete series of radiographic images |
2,150 |
2,083 |
$154K |
| D0140 |
Limited oral evaluation - problem focused |
3,764 |
3,569 |
$144K |
| D0330 |
Panoramic radiographic image |
3,184 |
3,052 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
7,150 |
6,891 |
$106K |
| D2950 |
|
665 |
532 |
$103K |
| D1351 |
Sealant - per tooth |
2,040 |
566 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,272 |
4,347 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
802 |
410 |
$57K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
101 |
63 |
$56K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
55 |
51 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,226 |
1,187 |
$33K |
| D4341 |
|
205 |
75 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
176 |
127 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
276 |
216 |
$23K |
| D2954 |
|
88 |
72 |
$15K |
| D5212 |
|
26 |
26 |
$14K |
| D7230 |
|
20 |
13 |
$5K |
| D2335 |
|
32 |
25 |
$5K |
| D7111 |
|
18 |
12 |
$1K |
| D2331 |
|
16 |
12 |
$1K |
| D1354 |
|
47 |
14 |
$525.00 |