| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
43,649 |
41,281 |
$1.41M |
| D0210 |
Intraoral - complete series of radiographic images |
19,941 |
18,520 |
$1.12M |
| D5110 |
|
2,591 |
2,517 |
$1.03M |
| D5120 |
|
1,825 |
1,773 |
$711K |
| D0120 |
Periodic oral evaluation - established patient |
42,484 |
40,755 |
$673K |
| D0230 |
Intraoral - periapical each additional radiographic image |
51,749 |
18,290 |
$645K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,717 |
3,080 |
$625K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24,024 |
22,346 |
$591K |
| D0140 |
Limited oral evaluation - problem focused |
5,046 |
4,784 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
20,455 |
19,343 |
$95K |
| D5520 |
|
1,391 |
783 |
$87K |
| D2330 |
|
1,377 |
692 |
$74K |
| D2331 |
|
1,340 |
782 |
$72K |
| D0470 |
|
2,326 |
2,225 |
$69K |
| D2335 |
|
919 |
290 |
$65K |
| D5750 |
|
373 |
359 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
844 |
472 |
$49K |
| D5512 |
|
758 |
710 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
728 |
540 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
298 |
234 |
$18K |
| D5751 |
|
106 |
101 |
$17K |
| D0274 |
Bitewings - four radiographic images |
569 |
551 |
$13K |
| D5214 |
|
25 |
24 |
$12K |
| D5511 |
|
158 |
144 |
$9K |
| D5213 |
|
16 |
16 |
$8K |
| D2332 |
|
98 |
64 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
336 |
333 |
$6K |
| D2394 |
|
32 |
26 |
$2K |
| D1120 |
Prophylaxis - child |
26 |
25 |
$500.00 |
| D1999 |
|
12 |
12 |
$0.00 |
| D5510 |
|
15 |
14 |
$0.00 |