| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
15,394 |
15,188 |
$842K |
| D0274 |
Bitewings - four radiographic images |
13,256 |
13,127 |
$507K |
| D0120 |
Periodic oral evaluation - established patient |
18,451 |
18,277 |
$458K |
| D0220 |
Intraoral - periapical first radiographic image |
17,773 |
17,256 |
$293K |
| D0210 |
Intraoral - complete series of radiographic images |
3,566 |
3,510 |
$260K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,571 |
8,549 |
$253K |
| D1120 |
Prophylaxis - child |
4,727 |
4,721 |
$243K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,792 |
1,903 |
$227K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,649 |
14,158 |
$209K |
| D2740 |
Crown - porcelain/ceramic |
304 |
184 |
$208K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,042 |
1,224 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,939 |
1,924 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,060 |
635 |
$80K |
| D1351 |
Sealant - per tooth |
1,399 |
456 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,209 |
1,164 |
$49K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
476 |
274 |
$44K |
| D2331 |
|
434 |
300 |
$39K |
| D4341 |
|
231 |
93 |
$29K |
| D1206 |
Topical application of fluoride varnish |
722 |
722 |
$28K |
| D7350 |
|
28 |
24 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
292 |
237 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
28 |
26 |
$22K |
| D1330 |
|
1,546 |
1,546 |
$22K |
| D2330 |
|
306 |
177 |
$20K |
| D4910 |
|
285 |
266 |
$18K |
| D9110 |
|
125 |
121 |
$5K |
| D2332 |
|
28 |
25 |
$3K |
| D7911 |
|
28 |
26 |
$3K |
| D2954 |
|
14 |
12 |
$3K |
| D0460 |
|
50 |
48 |
$1K |
| D2140 |
|
21 |
12 |
$1K |
| D0180 |
|
12 |
12 |
$509.25 |
| D0170 |
|
13 |
12 |
$468.00 |