| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
27,801 |
4,532 |
$849K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,549 |
4,551 |
$846K |
| D1120 |
Prophylaxis - child |
11,312 |
11,282 |
$457K |
| D1110 |
Prophylaxis - adult |
9,130 |
9,112 |
$433K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,520 |
3,001 |
$430K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,867 |
9,838 |
$387K |
| D0120 |
Periodic oral evaluation - established patient |
12,443 |
12,413 |
$335K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,432 |
1,822 |
$332K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,487 |
2,266 |
$300K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,522 |
11,486 |
$269K |
| D0210 |
Intraoral - complete series of radiographic images |
4,311 |
4,276 |
$264K |
| D0220 |
Intraoral - periapical first radiographic image |
14,946 |
14,721 |
$217K |
| D0274 |
Bitewings - four radiographic images |
7,123 |
7,101 |
$216K |
| D2740 |
Crown - porcelain/ceramic |
294 |
234 |
$195K |
| D0140 |
Limited oral evaluation - problem focused |
5,212 |
5,096 |
$181K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,198 |
11,208 |
$115K |
| D2950 |
|
457 |
390 |
$79K |
| D4341 |
|
513 |
273 |
$77K |
| D0272 |
Bitewings - two radiographic images |
3,032 |
3,027 |
$68K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
115 |
106 |
$66K |
| D2394 |
|
243 |
188 |
$46K |
| D2332 |
|
343 |
248 |
$41K |
| D2335 |
|
184 |
119 |
$28K |
| D2330 |
|
344 |
191 |
$25K |
| D4342 |
|
236 |
144 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
378 |
288 |
$22K |
| D3320 |
|
41 |
41 |
$21K |
| D2331 |
|
244 |
181 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
727 |
726 |
$20K |
| D0270 |
|
1,139 |
1,132 |
$13K |
| D5214 |
|
14 |
14 |
$11K |
| D4910 |
|
15 |
15 |
$1K |
| D1999 |
|
1,810 |
1,583 |
$0.00 |