| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,850 |
7,582 |
$399K |
| D8670 |
Periodic orthodontic treatment visit |
2,507 |
2,282 |
$375K |
| D0140 |
Limited oral evaluation - problem focused |
6,370 |
5,936 |
$224K |
| D0120 |
Periodic oral evaluation - established patient |
7,944 |
7,687 |
$187K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,379 |
668 |
$186K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,940 |
3,823 |
$109K |
| D0274 |
Bitewings - four radiographic images |
2,960 |
2,865 |
$99K |
| D1120 |
Prophylaxis - child |
1,896 |
1,849 |
$91K |
| D2740 |
Crown - porcelain/ceramic |
132 |
95 |
$82K |
| D0330 |
Panoramic radiographic image |
1,000 |
955 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,491 |
1,449 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
2,426 |
2,281 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
417 |
291 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
401 |
394 |
$27K |
| D7311 |
|
226 |
135 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
265 |
186 |
$21K |
| D9110 |
|
414 |
364 |
$14K |
| D2950 |
|
78 |
63 |
$12K |
| D8660 |
|
435 |
427 |
$12K |
| D8690 |
|
58 |
58 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
91 |
36 |
$6K |
| D9310 |
|
100 |
82 |
$5K |
| D4341 |
|
30 |
12 |
$4K |
| D3120 |
|
73 |
52 |
$2K |
| D1351 |
Sealant - per tooth |
53 |
12 |
$2K |
| D0270 |
|
85 |
85 |
$1K |
| D0180 |
|
20 |
20 |
$724.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
50 |
$602.00 |