| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,037 |
7,806 |
$286K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,534 |
2,189 |
$253K |
| D4341 |
|
3,646 |
972 |
$220K |
| D0120 |
Periodic oral evaluation - established patient |
12,203 |
11,827 |
$210K |
| D0274 |
Bitewings - four radiographic images |
6,837 |
6,618 |
$144K |
| D1120 |
Prophylaxis - child |
5,592 |
5,395 |
$143K |
| D1206 |
Topical application of fluoride varnish |
8,572 |
8,242 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,944 |
1,338 |
$99K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,125 |
850 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,608 |
3,486 |
$81K |
| D4910 |
|
1,275 |
1,253 |
$74K |
| D0272 |
Bitewings - two radiographic images |
2,357 |
2,268 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
577 |
274 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,248 |
3,032 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
658 |
651 |
$26K |
| D0330 |
Panoramic radiographic image |
1,393 |
1,347 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
721 |
691 |
$17K |
| D0601 |
|
2,711 |
2,665 |
$13K |
| D2740 |
Crown - porcelain/ceramic |
40 |
26 |
$11K |
| D2331 |
|
135 |
95 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
322 |
313 |
$7K |
| D0603 |
|
1,138 |
1,111 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
788 |
537 |
$4K |
| D0602 |
|
625 |
616 |
$3K |
| D1351 |
Sealant - per tooth |
127 |
33 |
$2K |
| D2332 |
|
13 |
12 |
$878.92 |