| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,638 |
10,480 |
$607K |
| D0330 |
Panoramic radiographic image |
6,788 |
6,738 |
$503K |
| D1120 |
Prophylaxis - child |
9,573 |
9,484 |
$483K |
| D0120 |
Periodic oral evaluation - established patient |
16,190 |
16,054 |
$428K |
| D1351 |
Sealant - per tooth |
10,262 |
2,804 |
$415K |
| D0274 |
Bitewings - four radiographic images |
10,103 |
10,020 |
$396K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,274 |
13,188 |
$380K |
| D2740 |
Crown - porcelain/ceramic |
493 |
335 |
$354K |
| D0220 |
Intraoral - periapical first radiographic image |
13,027 |
12,761 |
$227K |
| D2394 |
|
1,458 |
655 |
$216K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,992 |
11,594 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,021 |
3,991 |
$184K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,661 |
1,032 |
$149K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,225 |
657 |
$123K |
| D0140 |
Limited oral evaluation - problem focused |
2,605 |
2,507 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,421 |
835 |
$104K |
| D2950 |
|
410 |
287 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
334 |
175 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
409 |
233 |
$30K |
| D7311 |
|
261 |
212 |
$29K |
| D7230 |
|
35 |
13 |
$7K |
| D0272 |
Bitewings - two radiographic images |
160 |
158 |
$5K |
| D1206 |
Topical application of fluoride varnish |
81 |
81 |
$2K |
| D7111 |
|
21 |
12 |
$2K |
| D9110 |
|
14 |
14 |
$882.00 |