| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,114 |
5,801 |
$310K |
| D0120 |
Periodic oral evaluation - established patient |
9,301 |
8,937 |
$220K |
| D2740 |
Crown - porcelain/ceramic |
327 |
188 |
$214K |
| D1120 |
Prophylaxis - child |
3,828 |
3,752 |
$180K |
| D0274 |
Bitewings - four radiographic images |
4,473 |
4,234 |
$154K |
| D0140 |
Limited oral evaluation - problem focused |
3,852 |
3,562 |
$139K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,784 |
4,656 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,763 |
876 |
$103K |
| D0210 |
Intraoral - complete series of radiographic images |
1,518 |
1,480 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,112 |
656 |
$85K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
577 |
239 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,716 |
1,666 |
$73K |
| D1351 |
Sealant - per tooth |
1,638 |
400 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,534 |
3,251 |
$50K |
| D2950 |
|
319 |
209 |
$47K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
73 |
50 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,273 |
1,240 |
$37K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
52 |
41 |
$32K |
| D3320 |
|
63 |
44 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
363 |
176 |
$25K |
| D4341 |
|
176 |
61 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
151 |
103 |
$12K |
| D2954 |
|
59 |
37 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
353 |
208 |
$3K |
| D9410 |
|
13 |
13 |
$608.40 |
| D0270 |
|
92 |
15 |
$182.00 |