| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,678 |
8,487 |
$303K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
675 |
622 |
$272K |
| D2740 |
Crown - porcelain/ceramic |
255 |
113 |
$205K |
| D0274 |
Bitewings - four radiographic images |
8,686 |
8,504 |
$184K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,140 |
2,027 |
$153K |
| D0120 |
Periodic oral evaluation - established patient |
8,137 |
7,974 |
$143K |
| D3320 |
|
378 |
312 |
$112K |
| D0330 |
Panoramic radiographic image |
2,312 |
2,236 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,891 |
1,429 |
$100K |
| D2931 |
|
825 |
721 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,114 |
3,026 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,910 |
4,802 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
13,991 |
12,918 |
$74K |
| D2752 |
|
174 |
78 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,225 |
808 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,142 |
11,179 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
2,578 |
2,473 |
$61K |
| D1120 |
Prophylaxis - child |
2,611 |
2,555 |
$56K |
| D3310 |
|
94 |
44 |
$19K |
| D2950 |
|
144 |
94 |
$18K |
| D2330 |
|
368 |
244 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,602 |
1,568 |
$16K |
| D2140 |
|
363 |
212 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
192 |
129 |
$10K |
| D2335 |
|
83 |
56 |
$7K |
| D2332 |
|
80 |
59 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
220 |
198 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
59 |
$5K |
| D2952 |
|
21 |
14 |
$3K |
| D0273 |
|
13 |
13 |
$132.30 |