| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,422 |
4,400 |
$354K |
| D0120 |
Periodic oral evaluation - established patient |
7,420 |
7,373 |
$330K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
693 |
442 |
$330K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,559 |
1,972 |
$233K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,908 |
2,072 |
$209K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,146 |
3,132 |
$183K |
| D4910 |
|
2,381 |
2,373 |
$182K |
| D0210 |
Intraoral - complete series of radiographic images |
3,887 |
3,867 |
$166K |
| D1120 |
Prophylaxis - child |
4,383 |
4,362 |
$158K |
| D1351 |
Sealant - per tooth |
5,886 |
1,393 |
$149K |
| D4341 |
|
2,116 |
569 |
$140K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,442 |
7,119 |
$134K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,783 |
8,736 |
$108K |
| D0274 |
Bitewings - four radiographic images |
4,748 |
4,723 |
$92K |
| D9430 |
|
2,689 |
2,575 |
$79K |
| D2954 |
|
486 |
317 |
$51K |
| D2330 |
|
638 |
349 |
$48K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
104 |
86 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
282 |
185 |
$32K |
| D0350 |
|
3,350 |
1,131 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
390 |
194 |
$21K |
| D0330 |
Panoramic radiographic image |
631 |
628 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,221 |
2,117 |
$16K |
| D0272 |
Bitewings - two radiographic images |
594 |
592 |
$6K |
| D3320 |
|
14 |
12 |
$5K |
| D4342 |
|
83 |
25 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
25 |
$2K |
| D2331 |
|
17 |
15 |
$1K |
| D0270 |
|
244 |
241 |
$1K |
| D1999 |
|
132 |
130 |
$516.00 |
| D9951 |
|
13 |
13 |
$420.00 |
| D1330 |
|
464 |
451 |
$0.00 |