| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
19,315 |
19,310 |
$1.18M |
| D0120 |
Periodic oral evaluation - established patient |
19,269 |
19,266 |
$572K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,235 |
2,407 |
$348K |
| D0274 |
Bitewings - four radiographic images |
11,159 |
11,159 |
$348K |
| D0210 |
Intraoral - complete series of radiographic images |
11,984 |
11,949 |
$334K |
| D1120 |
Prophylaxis - child |
6,299 |
6,299 |
$287K |
| D0220 |
Intraoral - periapical first radiographic image |
15,031 |
14,978 |
$236K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,172 |
11,163 |
$220K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,124 |
6,124 |
$211K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,292 |
1,504 |
$157K |
| D1206 |
Topical application of fluoride varnish |
4,576 |
4,575 |
$155K |
| D2332 |
|
1,067 |
467 |
$134K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
153 |
98 |
$112K |
| D1351 |
Sealant - per tooth |
1,354 |
450 |
$108K |
| D2335 |
|
624 |
345 |
$106K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
796 |
648 |
$102K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,210 |
854 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,146 |
5,146 |
$74K |
| D2394 |
|
206 |
151 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
286 |
172 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
2,018 |
1,990 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,484 |
1,484 |
$26K |
| D2954 |
|
110 |
102 |
$19K |
| D2330 |
|
231 |
103 |
$16K |
| D0330 |
Panoramic radiographic image |
544 |
544 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
98 |
84 |
$14K |
| D2140 |
|
50 |
42 |
$5K |
| D2331 |
|
40 |
26 |
$4K |
| D1320 |
|
251 |
251 |
$2K |
| D9995 |
|
47 |
47 |
$1K |