| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,103 |
4,779 |
$257K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,266 |
584 |
$174K |
| D2335 |
|
1,216 |
355 |
$161K |
| D0210 |
Intraoral - complete series of radiographic images |
2,250 |
2,137 |
$155K |
| D0274 |
Bitewings - four radiographic images |
4,389 |
4,105 |
$153K |
| D0140 |
Limited oral evaluation - problem focused |
3,418 |
3,132 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,587 |
2,444 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,512 |
578 |
$100K |
| D2740 |
Crown - porcelain/ceramic |
193 |
81 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,037 |
524 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,667 |
3,437 |
$81K |
| D1120 |
Prophylaxis - child |
1,658 |
1,577 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
5,322 |
4,846 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,439 |
2,330 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,675 |
4,025 |
$59K |
| D1351 |
Sealant - per tooth |
1,598 |
351 |
$55K |
| D2332 |
|
205 |
98 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
200 |
117 |
$20K |
| D2950 |
|
58 |
29 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
13 |
$2K |
| D2330 |
|
27 |
15 |
$2K |
| D1999 |
|
16 |
15 |
$0.00 |