| Code | Description | Claims | Beneficiaries | Total Paid |
| D1110 |
Prophylaxis - adult |
22,091 |
22,083 |
$1.19M |
| D2750 |
|
1,322 |
996 |
$859K |
| D0120 |
Periodic oral evaluation - established patient |
19,551 |
19,548 |
$558K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,554 |
3,363 |
$458K |
| D0274 |
Bitewings - four radiographic images |
13,730 |
13,727 |
$391K |
| D0220 |
Intraoral - periapical first radiographic image |
22,298 |
22,104 |
$308K |
| D0210 |
Intraoral - complete series of radiographic images |
8,574 |
8,511 |
$296K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,357 |
1,066 |
$280K |
| D2954 |
|
1,349 |
1,132 |
$217K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,334 |
7,331 |
$193K |
| D1120 |
Prophylaxis - child |
3,593 |
3,592 |
$163K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,522 |
16,199 |
$162K |
| D7240 |
Removal of impacted tooth - completely bony |
322 |
178 |
$122K |
| D9243 |
|
812 |
809 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,910 |
1,353 |
$109K |
| D0330 |
Panoramic radiographic image |
3,015 |
3,014 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,804 |
5,803 |
$86K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
748 |
606 |
$83K |
| D1351 |
Sealant - per tooth |
936 |
476 |
$80K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
155 |
141 |
$63K |
| D9990 |
|
2,561 |
2,505 |
$56K |
| D9310 |
|
715 |
715 |
$55K |
| D9239 |
|
794 |
791 |
$53K |
| D8670 |
Periodic orthodontic treatment visit |
155 |
155 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
2,146 |
2,121 |
$31K |
| D0160 |
|
879 |
879 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,084 |
1,081 |
$21K |
| D1206 |
Topical application of fluoride varnish |
421 |
420 |
$15K |
| D0340 |
|
116 |
116 |
$6K |
| D9110 |
|
211 |
211 |
$5K |
| D4341 |
|
98 |
31 |
$5K |
| D3320 |
|
14 |
13 |
$4K |
| D0270 |
|
197 |
197 |
$3K |
| D2332 |
|
20 |
14 |
$3K |
| D8660 |
|
54 |
54 |
$1K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$1K |
| D2330 |
|
21 |
12 |
$997.48 |
| D0350 |
|
57 |
57 |
$741.28 |
| D9610 |
|
13 |
13 |
$185.15 |
| D1320 |
|
12 |
12 |
$96.00 |
| D0431 |
|
38 |
38 |
$0.00 |