| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,190 |
4,178 |
$357K |
| D4341 |
|
3,744 |
1,045 |
$260K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,103 |
4,090 |
$253K |
| D0120 |
Periodic oral evaluation - established patient |
4,447 |
4,432 |
$238K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,867 |
953 |
$219K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,168 |
1,809 |
$212K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,690 |
7,018 |
$141K |
| D4910 |
|
1,677 |
1,673 |
$129K |
| D0210 |
Intraoral - complete series of radiographic images |
2,757 |
2,746 |
$129K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,888 |
1,185 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,660 |
6,634 |
$84K |
| D0274 |
Bitewings - four radiographic images |
3,885 |
3,868 |
$82K |
| D1120 |
Prophylaxis - child |
2,099 |
2,091 |
$74K |
| D2330 |
|
781 |
422 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
707 |
234 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
488 |
393 |
$39K |
| D2335 |
|
299 |
153 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,284 |
2,265 |
$27K |
| D9430 |
|
785 |
780 |
$25K |
| D4342 |
|
231 |
78 |
$10K |
| D0350 |
|
1,074 |
555 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
19 |
16 |
$9K |
| D1351 |
Sealant - per tooth |
230 |
42 |
$8K |
| D2954 |
|
18 |
15 |
$2K |
| D0270 |
|
30 |
30 |
$150.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$144.00 |