| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
11,130 |
11,118 |
$478K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,448 |
2,372 |
$319K |
| D0120 |
Periodic oral evaluation - established patient |
13,478 |
13,467 |
$315K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
410 |
289 |
$231K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,174 |
12,157 |
$173K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,168 |
1,671 |
$163K |
| D0220 |
Intraoral - periapical first radiographic image |
14,272 |
14,256 |
$151K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,330 |
1,370 |
$145K |
| D0274 |
Bitewings - four radiographic images |
5,721 |
5,720 |
$139K |
| D2954 |
|
773 |
528 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
4,136 |
4,128 |
$63K |
| D1120 |
Prophylaxis - child |
1,041 |
1,041 |
$44K |
| D1351 |
Sealant - per tooth |
1,039 |
266 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,408 |
1,408 |
$36K |
| D2331 |
|
422 |
240 |
$30K |
| D2330 |
|
545 |
302 |
$28K |
| D3320 |
|
88 |
69 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
952 |
952 |
$13K |
| D4341 |
|
183 |
84 |
$8K |
| D2394 |
|
71 |
53 |
$7K |
| D3310 |
|
19 |
12 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
14 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
176 |
176 |
$4K |
| D9945 |
|
25 |
25 |
$3K |
| D2332 |
|
63 |
37 |
$2K |
| D2335 |
|
16 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
80 |
80 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
63 |
$726.98 |