| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,150 |
7,676 |
$334K |
| D0120 |
Periodic oral evaluation - established patient |
10,973 |
10,313 |
$305K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,613 |
2,982 |
$244K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,688 |
7,244 |
$200K |
| D1351 |
Sealant - per tooth |
2,443 |
1,591 |
$192K |
| D4341 |
|
1,104 |
702 |
$187K |
| D0274 |
Bitewings - four radiographic images |
7,246 |
6,816 |
$131K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,520 |
1,287 |
$126K |
| D1110 |
Prophylaxis - adult |
2,548 |
2,444 |
$111K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,007 |
718 |
$102K |
| D4342 |
|
875 |
593 |
$100K |
| D2740 |
Crown - porcelain/ceramic |
353 |
302 |
$98K |
| D9110 |
|
1,678 |
1,536 |
$90K |
| D0330 |
Panoramic radiographic image |
3,556 |
3,356 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,579 |
3,364 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,566 |
1,312 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
4,658 |
4,358 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
468 |
337 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,312 |
3,094 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,537 |
2,369 |
$24K |
| D2332 |
|
229 |
189 |
$22K |
| D2950 |
|
258 |
235 |
$18K |
| D2394 |
|
71 |
65 |
$5K |
| D9630 |
|
257 |
248 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
200 |
181 |
$3K |
| D4910 |
|
43 |
43 |
$3K |
| D2331 |
|
20 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
40 |
$835.40 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
12 |
$770.40 |
| D1999 |
|
2,091 |
1,615 |
$0.00 |