| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,134 |
5,063 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,165 |
1,010 |
$117K |
| D2740 |
Crown - porcelain/ceramic |
253 |
148 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,237 |
773 |
$81K |
| D0274 |
Bitewings - four radiographic images |
3,805 |
3,756 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,781 |
3,182 |
$57K |
| D2950 |
|
769 |
405 |
$56K |
| D7880 |
|
190 |
185 |
$53K |
| D0330 |
Panoramic radiographic image |
1,192 |
992 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
7,200 |
6,108 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
3,295 |
3,260 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
2,619 |
2,135 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,506 |
4,716 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,760 |
1,750 |
$28K |
| D1120 |
Prophylaxis - child |
620 |
620 |
$15K |
| D5211 |
|
12 |
12 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
26 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
26 |
$3K |
| D2332 |
|
18 |
15 |
$3K |
| D2330 |
|
26 |
12 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
51 |
51 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |
| D4341 |
|
135 |
53 |
$0.00 |