| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,543 |
8,983 |
$486K |
| D1120 |
Prophylaxis - child |
7,579 |
7,227 |
$369K |
| D0274 |
Bitewings - four radiographic images |
9,033 |
8,447 |
$307K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,829 |
6,427 |
$297K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,893 |
2,483 |
$284K |
| D0120 |
Periodic oral evaluation - established patient |
11,538 |
10,948 |
$282K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,653 |
2,624 |
$250K |
| D0220 |
Intraoral - periapical first radiographic image |
15,321 |
14,105 |
$236K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,015 |
7,612 |
$224K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,482 |
11,527 |
$189K |
| D0140 |
Limited oral evaluation - problem focused |
3,610 |
3,350 |
$130K |
| D2740 |
Crown - porcelain/ceramic |
176 |
75 |
$108K |
| D0272 |
Bitewings - two radiographic images |
2,343 |
2,206 |
$66K |
| D2950 |
|
395 |
234 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
773 |
360 |
$55K |
| D1351 |
Sealant - per tooth |
1,344 |
339 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
606 |
442 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
585 |
562 |
$40K |
| D2331 |
|
522 |
292 |
$37K |
| D1206 |
Topical application of fluoride varnish |
683 |
674 |
$17K |
| D3320 |
|
16 |
12 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
14 |
$8K |
| D2330 |
|
112 |
67 |
$7K |
| D2335 |
|
42 |
18 |
$5K |
| D2394 |
|
39 |
26 |
$4K |
| D2332 |
|
42 |
25 |
$4K |
| D0270 |
|
281 |
253 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
13 |
$3K |
| D9110 |
|
63 |
58 |
$2K |
| D1999 |
|
10,360 |
8,661 |
$0.00 |