| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
13,614 |
13,168 |
$703K |
| D6010 |
|
480 |
184 |
$515K |
| D4381 |
|
5,769 |
556 |
$471K |
| D0120 |
Periodic oral evaluation - established patient |
14,377 |
13,988 |
$340K |
| D8670 |
Periodic orthodontic treatment visit |
1,416 |
1,292 |
$337K |
| D0330 |
Panoramic radiographic image |
3,906 |
3,766 |
$224K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,848 |
7,605 |
$219K |
| D1120 |
Prophylaxis - child |
4,276 |
4,212 |
$215K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,443 |
1,530 |
$204K |
| D0274 |
Bitewings - four radiographic images |
5,868 |
5,701 |
$200K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,478 |
710 |
$197K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,413 |
8,548 |
$179K |
| D0220 |
Intraoral - periapical first radiographic image |
11,293 |
10,772 |
$170K |
| D0140 |
Limited oral evaluation - problem focused |
3,419 |
3,240 |
$127K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,894 |
1,096 |
$123K |
| D4341 |
|
570 |
183 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,922 |
1,874 |
$56K |
| D4910 |
|
620 |
582 |
$41K |
| D6057 |
|
88 |
27 |
$33K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
52 |
46 |
$30K |
| D1351 |
Sealant - per tooth |
664 |
176 |
$27K |
| D2740 |
Crown - porcelain/ceramic |
30 |
15 |
$21K |
| D0272 |
Bitewings - two radiographic images |
646 |
619 |
$17K |
| D9920 |
|
339 |
332 |
$14K |
| D1206 |
Topical application of fluoride varnish |
456 |
444 |
$12K |
| D0340 |
|
232 |
226 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
17 |
$10K |
| D2950 |
|
55 |
12 |
$8K |
| D1330 |
|
570 |
570 |
$8K |
| D9310 |
|
247 |
199 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
36 |
$4K |
| D2799 |
|
23 |
12 |
$4K |
| D4342 |
|
45 |
15 |
$4K |
| D8690 |
|
29 |
29 |
$4K |
| D8660 |
|
94 |
86 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$1K |
| D0470 |
|
14 |
14 |
$812.00 |
| D9910 |
|
21 |
15 |
$380.00 |
| D0270 |
|
27 |
26 |
$308.00 |
| D9630 |
|
23 |
16 |
$147.00 |
| D0350 |
|
116 |
115 |
$0.00 |
| D1999 |
|
82 |
80 |
$0.00 |