| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1310 |
|
10,452 |
10,414 |
$477K |
| D9993 |
|
2,689 |
2,686 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,215 |
2,208 |
$140K |
| D1120 |
Prophylaxis - child |
2,613 |
2,606 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,907 |
1,040 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,531 |
898 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
1,343 |
1,340 |
$85K |
| D1110 |
Prophylaxis - adult |
1,048 |
1,044 |
$82K |
| D0603 |
|
5,239 |
5,226 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,431 |
4,402 |
$76K |
| D1351 |
Sealant - per tooth |
1,694 |
484 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
1,227 |
1,222 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,935 |
2,321 |
$42K |
| D0602 |
|
2,580 |
2,560 |
$39K |
| D0601 |
|
2,497 |
2,494 |
$37K |
| D0145 |
Oral evaluation for a patient under three years of age |
261 |
261 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,402 |
1,356 |
$14K |
| D9999 |
Unspecified adjunctive procedure, by report |
114 |
97 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,027 |
1,025 |
$11K |
| D1320 |
|
749 |
748 |
$11K |
| D0350 |
|
1,457 |
591 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
170 |
76 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
124 |
81 |
$7K |
| D9430 |
|
138 |
134 |
$4K |
| D1206 |
Topical application of fluoride varnish |
128 |
128 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$894.60 |
| D0274 |
Bitewings - four radiographic images |
55 |
55 |
$558.00 |
| D0250 |
|
17 |
17 |
$330.00 |