| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
24,578 |
23,666 |
$1.31M |
| D0274 |
Bitewings - four radiographic images |
33,693 |
32,514 |
$1.23M |
| D1351 |
Sealant - per tooth |
24,719 |
7,580 |
$933K |
| D0120 |
Periodic oral evaluation - established patient |
37,743 |
36,537 |
$929K |
| D1120 |
Prophylaxis - child |
18,257 |
17,794 |
$900K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,184 |
6,078 |
$844K |
| D0220 |
Intraoral - periapical first radiographic image |
44,523 |
42,473 |
$722K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,815 |
24,079 |
$698K |
| D0230 |
Intraoral - periapical each additional radiographic image |
52,789 |
37,845 |
$615K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,591 |
3,711 |
$610K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,487 |
4,039 |
$572K |
| D2740 |
Crown - porcelain/ceramic |
527 |
307 |
$353K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,083 |
6,769 |
$311K |
| D2335 |
|
2,134 |
1,372 |
$300K |
| D2332 |
|
2,280 |
1,318 |
$257K |
| D0140 |
Limited oral evaluation - problem focused |
5,611 |
5,411 |
$218K |
| D2330 |
|
1,428 |
699 |
$99K |
| D0272 |
Bitewings - two radiographic images |
3,453 |
3,368 |
$99K |
| D2950 |
|
477 |
276 |
$73K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
501 |
370 |
$67K |
| D2394 |
|
271 |
182 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
266 |
165 |
$24K |
| D1206 |
Topical application of fluoride varnish |
959 |
950 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
236 |
172 |
$22K |
| D7111 |
|
166 |
87 |
$13K |
| D5212 |
|
16 |
16 |
$9K |
| D5211 |
|
15 |
15 |
$8K |
| D2954 |
|
21 |
12 |
$3K |
| D2331 |
|
15 |
13 |
$1K |
| D9110 |
|
15 |
14 |
$730.00 |
| D0270 |
|
43 |
42 |
$560.00 |
| D1999 |
|
21,542 |
19,029 |
$0.00 |