| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
21,321 |
20,083 |
$1.12M |
| D0120 |
Periodic oral evaluation - established patient |
29,208 |
27,612 |
$704K |
| D1120 |
Prophylaxis - child |
12,006 |
11,392 |
$589K |
| D1351 |
Sealant - per tooth |
10,198 |
2,669 |
$398K |
| D1206 |
Topical application of fluoride varnish |
15,745 |
14,920 |
$391K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,619 |
2,301 |
$304K |
| D0274 |
Bitewings - four radiographic images |
8,442 |
8,036 |
$304K |
| D2740 |
Crown - porcelain/ceramic |
422 |
328 |
$285K |
| D0210 |
Intraoral - complete series of radiographic images |
3,497 |
3,252 |
$233K |
| D0140 |
Limited oral evaluation - problem focused |
5,803 |
5,355 |
$220K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,218 |
1,894 |
$219K |
| D4341 |
|
969 |
350 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,251 |
645 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,084 |
1,971 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,116 |
2,943 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
5,523 |
5,111 |
$80K |
| D0272 |
Bitewings - two radiographic images |
2,747 |
2,608 |
$79K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
706 |
547 |
$66K |
| D4381 |
|
628 |
86 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
541 |
287 |
$48K |
| D0330 |
Panoramic radiographic image |
794 |
731 |
$46K |
| D2950 |
|
240 |
185 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
158 |
101 |
$21K |
| D4342 |
|
248 |
94 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
945 |
687 |
$11K |
| D2335 |
|
65 |
26 |
$9K |
| D9110 |
|
198 |
191 |
$8K |
| D2332 |
|
38 |
25 |
$4K |
| D2330 |
|
51 |
28 |
$3K |
| D7111 |
|
27 |
13 |
$2K |
| D4910 |
|
13 |
13 |
$990.00 |