| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2991 |
|
35,676 |
3,272 |
$3.81M |
| D1354 |
|
11,112 |
1,594 |
$324K |
| D1110 |
Prophylaxis - adult |
4,889 |
3,988 |
$266K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,806 |
833 |
$252K |
| D0330 |
Panoramic radiographic image |
3,240 |
2,504 |
$225K |
| D0274 |
Bitewings - four radiographic images |
5,007 |
4,039 |
$185K |
| D1330 |
|
5,577 |
4,539 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,593 |
964 |
$140K |
| D0140 |
Limited oral evaluation - problem focused |
3,700 |
3,025 |
$138K |
| D1206 |
Topical application of fluoride varnish |
4,598 |
3,951 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,585 |
2,834 |
$135K |
| D5225 |
|
84 |
84 |
$116K |
| D5226 |
|
86 |
86 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
6,488 |
5,268 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,434 |
4,516 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
2,655 |
2,352 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,258 |
726 |
$86K |
| D9944 |
|
61 |
61 |
$65K |
| D1120 |
Prophylaxis - child |
1,310 |
1,168 |
$54K |
| D1355 |
|
821 |
305 |
$42K |
| D4341 |
|
144 |
69 |
$31K |
| D1351 |
Sealant - per tooth |
860 |
163 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
201 |
134 |
$28K |
| D0350 |
|
1,692 |
1,648 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
226 |
154 |
$25K |
| D2331 |
|
247 |
132 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
189 |
152 |
$22K |
| D9110 |
|
437 |
345 |
$19K |
| D0240 |
|
451 |
191 |
$15K |
| D2330 |
|
197 |
104 |
$14K |
| D2335 |
|
111 |
70 |
$13K |
| D5221 |
|
12 |
12 |
$12K |
| D1310 |
|
358 |
358 |
$10K |
| D2140 |
|
94 |
53 |
$8K |
| D9985 |
|
3,370 |
661 |
$7K |
| D4910 |
|
67 |
62 |
$5K |
| D0272 |
Bitewings - two radiographic images |
101 |
94 |
$4K |
| D0180 |
|
28 |
28 |
$3K |
| D1320 |
|
43 |
43 |
$3K |
| D2160 |
|
20 |
17 |
$3K |
| D2332 |
|
13 |
13 |
$2K |
| D7111 |
|
16 |
12 |
$2K |
| D4355 |
|
15 |
15 |
$1K |