| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,778 |
5,593 |
$293K |
| D2740 |
Crown - porcelain/ceramic |
294 |
218 |
$204K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,057 |
1,329 |
$196K |
| D0274 |
Bitewings - four radiographic images |
5,400 |
5,247 |
$184K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,166 |
1,243 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
6,407 |
6,235 |
$148K |
| D0220 |
Intraoral - periapical first radiographic image |
8,987 |
8,547 |
$137K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
910 |
417 |
$128K |
| D0140 |
Limited oral evaluation - problem focused |
3,437 |
3,239 |
$126K |
| D1120 |
Prophylaxis - child |
2,627 |
2,568 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,318 |
2,245 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,267 |
6,260 |
$91K |
| D2950 |
|
519 |
424 |
$80K |
| D1206 |
Topical application of fluoride varnish |
2,035 |
2,008 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
623 |
599 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,494 |
1,451 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,353 |
1,320 |
$38K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
67 |
38 |
$31K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
42 |
41 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
404 |
255 |
$29K |
| D2335 |
|
91 |
64 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
120 |
76 |
$11K |
| D1351 |
Sealant - per tooth |
243 |
71 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
109 |
56 |
$10K |
| D7311 |
|
77 |
61 |
$9K |
| D4341 |
|
70 |
27 |
$9K |
| D2394 |
|
62 |
43 |
$8K |
| D2332 |
|
69 |
42 |
$8K |
| D2140 |
|
56 |
28 |
$4K |
| D2331 |
|
39 |
14 |
$3K |
| D2330 |
|
44 |
17 |
$3K |
| D9430 |
|
12 |
12 |
$0.00 |