| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,389 |
8,008 |
$473K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,742 |
960 |
$367K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,720 |
1,031 |
$290K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,720 |
11,301 |
$258K |
| D0220 |
Intraoral - periapical first radiographic image |
17,539 |
15,886 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
8,471 |
8,142 |
$223K |
| D0274 |
Bitewings - four radiographic images |
5,669 |
5,453 |
$180K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,993 |
584 |
$162K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,966 |
2,888 |
$161K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,569 |
9,853 |
$130K |
| D0140 |
Limited oral evaluation - problem focused |
3,014 |
2,806 |
$126K |
| D0330 |
Panoramic radiographic image |
1,939 |
1,882 |
$126K |
| D9944 |
|
316 |
306 |
$106K |
| D2750 |
|
216 |
117 |
$97K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
500 |
283 |
$64K |
| D1351 |
Sealant - per tooth |
1,525 |
233 |
$53K |
| D0350 |
|
1,151 |
1,101 |
$51K |
| D0460 |
|
1,735 |
1,630 |
$39K |
| D4355 |
|
373 |
366 |
$37K |
| D5214 |
|
44 |
40 |
$36K |
| D4342 |
|
359 |
94 |
$25K |
| D0180 |
|
420 |
383 |
$23K |
| D1120 |
Prophylaxis - child |
496 |
484 |
$20K |
| D3110 |
|
484 |
131 |
$15K |
| D2330 |
|
200 |
90 |
$15K |
| D5213 |
|
13 |
13 |
$13K |
| D9310 |
|
150 |
150 |
$13K |
| D2332 |
|
105 |
41 |
$12K |
| D2394 |
|
75 |
45 |
$12K |
| D4346 |
|
105 |
105 |
$10K |
| D5110 |
|
12 |
12 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$8K |
| D2335 |
|
54 |
12 |
$8K |
| D4341 |
|
54 |
14 |
$7K |
| D2799 |
|
30 |
15 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
39 |
$6K |
| D0272 |
Bitewings - two radiographic images |
161 |
153 |
$4K |
| D2954 |
|
42 |
27 |
$3K |
| D9430 |
|
41 |
40 |
$1K |
| D8670 |
Periodic orthodontic treatment visit |
377 |
377 |
$0.00 |