| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
24,338 |
23,914 |
$992K |
| D9410 |
|
6,647 |
6,092 |
$991K |
| D5110 |
|
1,093 |
1,083 |
$604K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,668 |
2,581 |
$579K |
| D5120 |
|
829 |
823 |
$454K |
| D0120 |
Periodic oral evaluation - established patient |
20,079 |
19,800 |
$449K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,515 |
9,388 |
$209K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,467 |
3,415 |
$187K |
| D0210 |
Intraoral - complete series of radiographic images |
2,415 |
2,381 |
$131K |
| D1330 |
|
6,051 |
5,791 |
$53K |
| D5214 |
|
95 |
93 |
$51K |
| D1310 |
|
6,040 |
5,779 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
837 |
798 |
$41K |
| D2332 |
|
218 |
146 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,505 |
1,449 |
$13K |
| D2335 |
|
155 |
112 |
$10K |
| D1120 |
Prophylaxis - child |
404 |
386 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
473 |
452 |
$8K |
| D5213 |
|
13 |
13 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
161 |
137 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
51 |
37 |
$3K |
| D1351 |
Sealant - per tooth |
93 |
14 |
$3K |
| D2330 |
|
47 |
25 |
$2K |
| D5411 |
|
95 |
95 |
$2K |
| D0274 |
Bitewings - four radiographic images |
65 |
62 |
$2K |
| D5510 |
|
24 |
24 |
$1K |
| D0601 |
|
145 |
132 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$910.00 |
| D2331 |
|
15 |
12 |
$900.00 |
| D5410 |
|
24 |
24 |
$480.00 |
| D1999 |
|
42 |
39 |
$217.00 |