| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,156 |
9,992 |
$512K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,801 |
12,588 |
$369K |
| D0120 |
Periodic oral evaluation - established patient |
12,631 |
12,438 |
$357K |
| D1351 |
Sealant - per tooth |
9,376 |
2,681 |
$351K |
| D2740 |
Crown - porcelain/ceramic |
491 |
312 |
$333K |
| D1110 |
Prophylaxis - adult |
4,448 |
4,390 |
$274K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,139 |
1,273 |
$269K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,594 |
910 |
$170K |
| D0274 |
Bitewings - four radiographic images |
2,398 |
2,349 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,986 |
1,949 |
$94K |
| D0330 |
Panoramic radiographic image |
1,225 |
1,210 |
$85K |
| D0272 |
Bitewings - two radiographic images |
2,197 |
2,153 |
$66K |
| D2950 |
|
235 |
196 |
$39K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
45 |
39 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,616 |
1,566 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
981 |
851 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
60 |
$10K |
| D2140 |
|
132 |
79 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
110 |
79 |
$10K |
| D2954 |
|
44 |
37 |
$8K |
| D9110 |
|
142 |
139 |
$6K |
| D7111 |
|
70 |
52 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
18 |
17 |
$728.00 |