| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,198 |
1,187 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,170 |
1,155 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
184 |
97 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,556 |
1,486 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
35 |
26 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
959 |
937 |
$15K |
| D0350 |
|
386 |
377 |
$12K |
| D0274 |
Bitewings - four radiographic images |
338 |
331 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
37 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
243 |
243 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
196 |
193 |
$7K |
| D0460 |
|
202 |
197 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
89 |
87 |
$4K |
| D0330 |
Panoramic radiographic image |
71 |
71 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
12 |
$4K |
| D2950 |
|
21 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
34 |
31 |
$563.04 |