| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,960 |
5,141 |
$751K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,891 |
4,328 |
$578K |
| D1120 |
Prophylaxis - child |
12,032 |
11,577 |
$494K |
| D0120 |
Periodic oral evaluation - established patient |
15,817 |
15,158 |
$436K |
| D4341 |
|
2,314 |
1,166 |
$333K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,107 |
11,652 |
$311K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,042 |
2,700 |
$281K |
| D2332 |
|
2,739 |
1,788 |
$280K |
| D1110 |
Prophylaxis - adult |
6,329 |
6,174 |
$275K |
| D2160 |
|
1,927 |
1,471 |
$173K |
| D0274 |
Bitewings - four radiographic images |
9,462 |
9,165 |
$171K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,780 |
6,575 |
$157K |
| D5110 |
|
345 |
342 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,888 |
1,448 |
$122K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,354 |
1,097 |
$116K |
| D0220 |
Intraoral - periapical first radiographic image |
16,777 |
15,863 |
$103K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,769 |
9,860 |
$96K |
| D5120 |
|
214 |
213 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
4,897 |
4,656 |
$85K |
| D2140 |
|
1,817 |
1,361 |
$76K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
909 |
676 |
$75K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
194 |
135 |
$53K |
| D0272 |
Bitewings - two radiographic images |
4,099 |
3,873 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
760 |
597 |
$29K |
| D2331 |
|
299 |
230 |
$24K |
| D2330 |
|
308 |
241 |
$19K |
| D2335 |
|
175 |
134 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
412 |
406 |
$8K |
| D4342 |
|
17 |
14 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
31 |
27 |
$2K |
| D1999 |
|
701 |
543 |
$0.00 |