| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,099 |
5,967 |
$330K |
| D2740 |
Crown - porcelain/ceramic |
411 |
330 |
$283K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,333 |
1,643 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
7,105 |
6,994 |
$174K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,487 |
1,019 |
$173K |
| D0274 |
Bitewings - four radiographic images |
4,670 |
4,573 |
$166K |
| D1120 |
Prophylaxis - child |
2,574 |
2,537 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
8,082 |
7,774 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,710 |
3,679 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
2,696 |
2,589 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,008 |
1,958 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,015 |
5,449 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,028 |
717 |
$66K |
| D2950 |
|
388 |
319 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
452 |
440 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
233 |
194 |
$22K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
38 |
30 |
$22K |
| D2954 |
|
109 |
81 |
$19K |
| D0272 |
Bitewings - two radiographic images |
447 |
442 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$7K |
| D2330 |
|
53 |
24 |
$4K |
| D2331 |
|
31 |
26 |
$3K |
| D0270 |
|
156 |
154 |
$2K |
| D1351 |
Sealant - per tooth |
42 |
12 |
$2K |
| D0170 |
|
13 |
13 |
$0.00 |
| D9996 |
|
22 |
22 |
$0.00 |