| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,336 |
5,198 |
$284K |
| D2740 |
Crown - porcelain/ceramic |
300 |
242 |
$205K |
| D0210 |
Intraoral - complete series of radiographic images |
2,346 |
2,278 |
$169K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,229 |
747 |
$164K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,624 |
1,082 |
$140K |
| D0274 |
Bitewings - four radiographic images |
3,626 |
3,474 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
5,103 |
4,951 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,236 |
2,171 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,335 |
755 |
$84K |
| D2954 |
|
419 |
366 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,372 |
2,292 |
$68K |
| D1120 |
Prophylaxis - child |
1,314 |
1,262 |
$66K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
88 |
70 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,458 |
2,362 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
478 |
239 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
474 |
445 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
124 |
101 |
$12K |
| D1351 |
Sealant - per tooth |
289 |
96 |
$12K |
| D9110 |
|
106 |
105 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
290 |
207 |
$4K |
| D0272 |
Bitewings - two radiographic images |
42 |
42 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
12 |
$1K |