| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
12,036 |
11,980 |
$1.03M |
| D0120 |
Periodic oral evaluation - established patient |
14,382 |
14,319 |
$899K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,806 |
10,777 |
$691K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,529 |
4,322 |
$568K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,788 |
3,110 |
$555K |
| D1120 |
Prophylaxis - child |
11,250 |
11,205 |
$461K |
| D0210 |
Intraoral - complete series of radiographic images |
7,218 |
7,195 |
$341K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,106 |
23,016 |
$305K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,389 |
3,050 |
$292K |
| D2740 |
Crown - porcelain/ceramic |
382 |
255 |
$181K |
| D1351 |
Sealant - per tooth |
6,132 |
1,493 |
$181K |
| D0274 |
Bitewings - four radiographic images |
8,384 |
8,355 |
$169K |
| D4341 |
|
2,059 |
577 |
$144K |
| D2330 |
|
1,859 |
986 |
$143K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,199 |
15,340 |
$120K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,082 |
981 |
$118K |
| D0330 |
Panoramic radiographic image |
4,247 |
4,228 |
$114K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,369 |
955 |
$109K |
| D0272 |
Bitewings - two radiographic images |
7,282 |
7,255 |
$85K |
| D7230 |
|
410 |
263 |
$77K |
| D9430 |
|
2,395 |
2,252 |
$76K |
| D0350 |
|
5,329 |
1,863 |
$47K |
| D2335 |
|
240 |
101 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,986 |
1,886 |
$24K |
| D4910 |
|
210 |
210 |
$16K |
| D2331 |
|
177 |
124 |
$14K |
| D7111 |
|
92 |
65 |
$5K |
| D4342 |
|
51 |
21 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
29 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
88 |
$0.00 |