| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,688 |
3,554 |
$190K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,574 |
953 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
4,529 |
4,396 |
$106K |
| D0274 |
Bitewings - four radiographic images |
2,951 |
2,855 |
$104K |
| D2740 |
Crown - porcelain/ceramic |
148 |
95 |
$99K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
984 |
576 |
$86K |
| D1120 |
Prophylaxis - child |
1,591 |
1,558 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
957 |
916 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,370 |
2,308 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,771 |
1,688 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,131 |
617 |
$63K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
118 |
81 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,396 |
1,339 |
$57K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
89 |
71 |
$54K |
| D2950 |
|
220 |
177 |
$33K |
| D1351 |
Sealant - per tooth |
824 |
213 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,663 |
1,577 |
$24K |
| D2394 |
|
198 |
137 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
151 |
88 |
$20K |
| D4341 |
|
239 |
64 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
84 |
$11K |
| D4342 |
|
140 |
38 |
$9K |
| D0272 |
Bitewings - two radiographic images |
236 |
234 |
$7K |
| D2330 |
|
42 |
25 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
296 |
159 |
$3K |
| D3120 |
|
31 |
19 |
$1K |