| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,820 |
8,413 |
$443K |
| D2740 |
Crown - porcelain/ceramic |
481 |
280 |
$296K |
| D0274 |
Bitewings - four radiographic images |
6,990 |
6,697 |
$245K |
| D0120 |
Periodic oral evaluation - established patient |
8,509 |
8,176 |
$193K |
| D0140 |
Limited oral evaluation - problem focused |
4,497 |
4,206 |
$163K |
| D0210 |
Intraoral - complete series of radiographic images |
1,924 |
1,828 |
$132K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
934 |
432 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,618 |
2,484 |
$103K |
| D1120 |
Prophylaxis - child |
1,989 |
1,944 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
5,761 |
5,180 |
$81K |
| D1206 |
Topical application of fluoride varnish |
1,845 |
1,792 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
506 |
322 |
$38K |
| D2950 |
|
226 |
148 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,047 |
1,021 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
392 |
198 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,723 |
1,219 |
$18K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
34 |
23 |
$17K |
| D1351 |
Sealant - per tooth |
452 |
112 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
91 |
52 |
$7K |
| D5211 |
|
14 |
12 |
$6K |
| D2331 |
|
30 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
81 |
79 |
$2K |
| D0330 |
Panoramic radiographic image |
17 |
15 |
$538.00 |
| D1330 |
|
18 |
18 |
$0.00 |