| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
17,669 |
16,783 |
$920K |
| D0274 |
Bitewings - four radiographic images |
19,510 |
18,517 |
$680K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,541 |
4,396 |
$631K |
| D0120 |
Periodic oral evaluation - established patient |
24,363 |
23,212 |
$585K |
| D1120 |
Prophylaxis - child |
11,771 |
11,354 |
$582K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,906 |
15,375 |
$451K |
| D2740 |
Crown - porcelain/ceramic |
583 |
352 |
$405K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,551 |
2,761 |
$400K |
| D0140 |
Limited oral evaluation - problem focused |
10,326 |
9,730 |
$385K |
| D1351 |
Sealant - per tooth |
9,064 |
2,410 |
$355K |
| D0220 |
Intraoral - periapical first radiographic image |
21,955 |
20,301 |
$325K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,920 |
6,670 |
$293K |
| D2394 |
|
2,502 |
1,505 |
$291K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,788 |
12,321 |
$222K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,486 |
1,734 |
$216K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,063 |
1,602 |
$193K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,381 |
985 |
$190K |
| D2950 |
|
797 |
571 |
$125K |
| D0272 |
Bitewings - two radiographic images |
3,806 |
3,721 |
$109K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
203 |
116 |
$106K |
| D2335 |
|
769 |
471 |
$101K |
| D2332 |
|
600 |
361 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
313 |
293 |
$21K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
26 |
24 |
$15K |
| D2331 |
|
135 |
94 |
$12K |
| D4341 |
|
92 |
41 |
$9K |
| D0270 |
|
267 |
263 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
48 |
28 |
$3K |
| D2330 |
|
44 |
25 |
$3K |
| D9110 |
|
12 |
12 |
$420.00 |
| D1206 |
Topical application of fluoride varnish |
14 |
13 |
$286.00 |
| D1999 |
|
22,111 |
18,583 |
$0.00 |