| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D5110 |
|
3,168 |
2,972 |
$1.62M |
| D5120 |
|
2,115 |
2,009 |
$1.08M |
| D1110 |
Prophylaxis - adult |
14,602 |
14,478 |
$539K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,150 |
4,272 |
$513K |
| D0120 |
Periodic oral evaluation - established patient |
19,068 |
18,912 |
$348K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,711 |
22,505 |
$346K |
| D2752 |
|
781 |
521 |
$305K |
| D0210 |
Intraoral - complete series of radiographic images |
5,067 |
5,001 |
$247K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,498 |
1,098 |
$241K |
| D0274 |
Bitewings - four radiographic images |
9,250 |
9,153 |
$222K |
| D4910 |
|
3,542 |
3,519 |
$214K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,396 |
9,289 |
$214K |
| D0140 |
Limited oral evaluation - problem focused |
7,711 |
7,582 |
$190K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,466 |
1,683 |
$185K |
| D1351 |
Sealant - per tooth |
7,570 |
789 |
$149K |
| D5214 |
|
286 |
239 |
$143K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,759 |
799 |
$139K |
| D1120 |
Prophylaxis - child |
5,071 |
5,007 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,184 |
1,365 |
$112K |
| D2950 |
|
1,013 |
778 |
$100K |
| D2332 |
|
1,154 |
591 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
6,697 |
6,543 |
$66K |
| D0330 |
Panoramic radiographic image |
1,823 |
1,804 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,540 |
3,010 |
$50K |
| D5213 |
|
107 |
84 |
$50K |
| D4341 |
|
372 |
175 |
$34K |
| D5750 |
|
164 |
163 |
$26K |
| D0603 |
|
5,348 |
5,294 |
$24K |
| D2740 |
Crown - porcelain/ceramic |
53 |
38 |
$20K |
| D2335 |
|
188 |
112 |
$15K |
| D0460 |
|
677 |
663 |
$11K |
| D0601 |
|
1,956 |
1,919 |
$9K |
| D2331 |
|
130 |
92 |
$8K |
| D0272 |
Bitewings - two radiographic images |
265 |
263 |
$4K |
| D2394 |
|
50 |
37 |
$4K |
| D5751 |
|
25 |
25 |
$4K |
| D1354 |
|
623 |
128 |
$4K |
| D0602 |
|
463 |
455 |
$2K |
| D4355 |
|
38 |
38 |
$2K |
| D5410 |
|
14 |
14 |
$286.73 |
| D1330 |
|
14 |
12 |
$0.00 |