| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
36,636 |
36,460 |
$1.88M |
| D0120 |
Periodic oral evaluation - established patient |
57,666 |
57,347 |
$1.78M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23,344 |
13,102 |
$1.72M |
| D2722 |
|
1,343 |
911 |
$1.28M |
| D0274 |
Bitewings - four radiographic images |
35,020 |
34,849 |
$1.23M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18,813 |
10,524 |
$1.09M |
| D1351 |
Sealant - per tooth |
27,415 |
8,234 |
$893K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,546 |
5,195 |
$772K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,099 |
5,484 |
$756K |
| D1206 |
Topical application of fluoride varnish |
27,816 |
27,717 |
$740K |
| D1120 |
Prophylaxis - child |
20,537 |
20,472 |
$730K |
| D2332 |
|
6,092 |
3,773 |
$652K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,284 |
4,072 |
$466K |
| D3320 |
|
1,274 |
1,111 |
$448K |
| D0220 |
Intraoral - periapical first radiographic image |
26,322 |
25,935 |
$356K |
| D0272 |
Bitewings - two radiographic images |
11,140 |
11,100 |
$348K |
| D2160 |
|
2,969 |
2,316 |
$318K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,945 |
16,278 |
$310K |
| D2140 |
|
4,485 |
2,776 |
$310K |
| D2335 |
|
2,781 |
1,875 |
$298K |
| D2330 |
|
3,924 |
2,547 |
$242K |
| D0330 |
Panoramic radiographic image |
4,667 |
4,635 |
$241K |
| D7111 |
|
2,454 |
1,736 |
$230K |
| D1330 |
|
6,121 |
6,108 |
$222K |
| D0140 |
Limited oral evaluation - problem focused |
6,389 |
6,244 |
$211K |
| D2331 |
|
2,288 |
1,685 |
$193K |
| D3310 |
|
740 |
567 |
$185K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
599 |
530 |
$74K |
| D2394 |
|
577 |
490 |
$55K |
| D2161 |
|
420 |
377 |
$51K |
| D5214 |
|
66 |
64 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,794 |
2,778 |
$46K |
| D9944 |
|
60 |
60 |
$37K |
| D4355 |
|
1,057 |
1,052 |
$31K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
29 |
29 |
$20K |
| D5225 |
|
13 |
13 |
$18K |
| D5226 |
|
12 |
12 |
$17K |
| D5213 |
|
12 |
12 |
$12K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
311 |
262 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
141 |
141 |
$6K |
| D0270 |
|
50 |
50 |
$363.48 |
| D0273 |
|
12 |
12 |
$0.00 |
| D9996 |
|
16 |
15 |
$0.00 |