| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
7,512 |
6,798 |
$201K |
| D0274 |
Bitewings - four radiographic images |
6,033 |
5,857 |
$181K |
| D1110 |
Prophylaxis - adult |
4,834 |
4,671 |
$165K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,187 |
1,119 |
$160K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,857 |
6,679 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
5,981 |
5,822 |
$141K |
| D0330 |
Panoramic radiographic image |
2,583 |
2,227 |
$118K |
| D1120 |
Prophylaxis - child |
2,582 |
2,525 |
$111K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
249 |
161 |
$109K |
| D2954 |
|
675 |
409 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,259 |
629 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,892 |
1,693 |
$77K |
| D2394 |
|
580 |
385 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
6,109 |
5,709 |
$66K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
100 |
65 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,701 |
2,557 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
487 |
278 |
$42K |
| D7250 |
|
222 |
76 |
$31K |
| D2791 |
|
69 |
53 |
$30K |
| D2335 |
|
240 |
142 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
301 |
171 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
249 |
151 |
$22K |
| D2940 |
|
623 |
432 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
183 |
96 |
$15K |
| D2331 |
|
158 |
80 |
$13K |
| D2160 |
|
142 |
91 |
$11K |
| D3320 |
|
14 |
12 |
$10K |
| D2332 |
|
61 |
43 |
$6K |
| D2330 |
|
99 |
38 |
$5K |
| D1351 |
Sealant - per tooth |
62 |
13 |
$2K |
| D2161 |
|
15 |
12 |
$1K |
| D7510 |
|
35 |
34 |
$1K |
| D0470 |
|
19 |
16 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$852.80 |
| D2920 |
|
36 |
24 |
$807.75 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$276.08 |
| D1320 |
|
45 |
43 |
$203.34 |