| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
15,878 |
15,819 |
$781K |
| D1351 |
Sealant - per tooth |
23,394 |
4,146 |
$684K |
| D0274 |
Bitewings - four radiographic images |
15,765 |
15,708 |
$594K |
| D0330 |
Panoramic radiographic image |
7,181 |
7,137 |
$538K |
| D0180 |
|
4,537 |
4,510 |
$530K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,531 |
10,483 |
$443K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,534 |
16,462 |
$424K |
| D1120 |
Prophylaxis - child |
8,582 |
8,554 |
$306K |
| D0120 |
Periodic oral evaluation - established patient |
10,303 |
10,264 |
$266K |
| D1330 |
|
6,843 |
6,794 |
$202K |
| D0140 |
Limited oral evaluation - problem focused |
4,684 |
4,467 |
$180K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,854 |
1,138 |
$158K |
| D1206 |
Topical application of fluoride varnish |
6,288 |
6,258 |
$155K |
| D9945 |
|
161 |
161 |
$150K |
| D5226 |
|
120 |
120 |
$124K |
| D4341 |
|
503 |
187 |
$108K |
| D2394 |
|
632 |
493 |
$85K |
| D4910 |
|
1,031 |
1,020 |
$84K |
| D1310 |
|
1,515 |
1,511 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
929 |
637 |
$66K |
| D9944 |
|
89 |
89 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
427 |
379 |
$47K |
| D5225 |
|
39 |
39 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
1,853 |
1,822 |
$27K |
| D2740 |
Crown - porcelain/ceramic |
26 |
12 |
$26K |
| D9920 |
|
597 |
572 |
$25K |
| D2161 |
|
155 |
132 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
302 |
198 |
$14K |
| D9110 |
|
279 |
271 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
674 |
406 |
$7K |
| D2160 |
|
30 |
25 |
$3K |
| D2950 |
|
13 |
12 |
$3K |
| D2335 |
|
16 |
13 |
$3K |
| D0272 |
Bitewings - two radiographic images |
55 |
55 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
12 |
$2K |
| D9985 |
|
159 |
149 |
$6.86 |
| D1999 |
|
18 |
18 |
$0.00 |
| D4355 |
|
14 |
14 |
$0.00 |
| D9995 |
|
19 |
14 |
$0.00 |