| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,426 |
4,415 |
$316K |
| D0120 |
Periodic oral evaluation - established patient |
6,213 |
6,196 |
$268K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,400 |
2,140 |
$262K |
| D1206 |
Topical application of fluoride varnish |
9,011 |
8,968 |
$243K |
| D1120 |
Prophylaxis - child |
4,219 |
4,207 |
$196K |
| D1351 |
Sealant - per tooth |
5,355 |
1,235 |
$186K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,313 |
3,300 |
$180K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
403 |
307 |
$167K |
| D2740 |
Crown - porcelain/ceramic |
294 |
215 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,852 |
1,265 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
9,428 |
9,301 |
$80K |
| D1310 |
|
2,836 |
2,834 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,592 |
8,529 |
$72K |
| D0274 |
Bitewings - four radiographic images |
5,750 |
5,736 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,389 |
891 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
736 |
592 |
$51K |
| D9430 |
|
1,533 |
1,476 |
$33K |
| D4341 |
|
663 |
252 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
1,053 |
1,051 |
$29K |
| D1320 |
|
3,696 |
3,680 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
315 |
315 |
$18K |
| D0601 |
|
2,431 |
2,428 |
$16K |
| D0272 |
Bitewings - two radiographic images |
787 |
786 |
$8K |
| D0603 |
|
1,192 |
1,191 |
$7K |
| D2330 |
|
145 |
89 |
$6K |
| D4910 |
|
124 |
124 |
$6K |
| D2954 |
|
62 |
51 |
$4K |
| D0602 |
|
745 |
744 |
$3K |
| D2331 |
|
29 |
25 |
$1K |
| D2332 |
|
16 |
13 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$499.20 |
| D0140 |
Limited oral evaluation - problem focused |
70 |
70 |
$455.00 |
| D9993 |
|
1,662 |
1,659 |
$0.00 |