| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,720 |
4,690 |
$370K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,417 |
3,054 |
$344K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,709 |
3,684 |
$208K |
| D4341 |
|
2,902 |
813 |
$200K |
| D2330 |
|
2,592 |
1,478 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
4,639 |
4,617 |
$176K |
| D1120 |
Prophylaxis - child |
3,064 |
3,044 |
$118K |
| D4910 |
|
1,380 |
1,379 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,391 |
7,357 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,941 |
1,921 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,168 |
948 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
4,581 |
4,482 |
$58K |
| D0330 |
Panoramic radiographic image |
1,671 |
1,663 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,029 |
4,174 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,461 |
2,449 |
$31K |
| D9430 |
|
770 |
759 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
182 |
136 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
314 |
203 |
$17K |
| D1351 |
Sealant - per tooth |
592 |
147 |
$13K |
| D5110 |
|
16 |
16 |
$9K |
| D2740 |
Crown - porcelain/ceramic |
20 |
15 |
$9K |
| D2954 |
|
52 |
43 |
$5K |
| D2335 |
|
45 |
25 |
$5K |
| D2331 |
|
22 |
12 |
$2K |