| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,225 |
4,049 |
$212K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,354 |
842 |
$180K |
| D0274 |
Bitewings - four radiographic images |
3,056 |
2,922 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,454 |
2,347 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,072 |
561 |
$71K |
| D0330 |
Panoramic radiographic image |
1,205 |
1,166 |
$65K |
| D1206 |
Topical application of fluoride varnish |
3,179 |
3,057 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,562 |
2,461 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
2,811 |
2,625 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,280 |
1,219 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,358 |
1,302 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
55 |
50 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
13 |
13 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
145 |
133 |
$9K |
| D0270 |
|
417 |
408 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
696 |
633 |
$6K |
| D1120 |
Prophylaxis - child |
50 |
50 |
$2K |
| D2331 |
|
17 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
12 |
$2K |