| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,662 |
2,639 |
$225K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,491 |
2,477 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
2,563 |
2,545 |
$154K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
292 |
215 |
$139K |
| D1120 |
Prophylaxis - child |
3,300 |
3,260 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
1,930 |
1,913 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,490 |
905 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,983 |
5,936 |
$82K |
| D1351 |
Sealant - per tooth |
1,504 |
360 |
$52K |
| D4341 |
|
683 |
254 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,571 |
4,449 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,738 |
1,722 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
462 |
285 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,005 |
1,982 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
258 |
167 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
24 |
24 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
473 |
473 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
69 |
$5K |
| D3320 |
|
14 |
12 |
$5K |
| D9430 |
|
100 |
100 |
$3K |
| D2931 |
|
13 |
12 |
$2K |
| D4910 |
|
12 |
12 |
$924.00 |
| D1999 |
|
41 |
40 |
$0.00 |