| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,375 |
3,096 |
$159K |
| D2740 |
Crown - porcelain/ceramic |
209 |
140 |
$130K |
| D0274 |
Bitewings - four radiographic images |
3,029 |
2,884 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,007 |
1,818 |
$74K |
| D0330 |
Panoramic radiographic image |
1,409 |
1,266 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,320 |
3,115 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,228 |
1,155 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
2,031 |
1,918 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,339 |
2,016 |
$28K |
| D2950 |
|
172 |
125 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
604 |
574 |
$17K |
| D1120 |
Prophylaxis - child |
335 |
326 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
122 |
51 |
$10K |
| D5212 |
|
16 |
16 |
$9K |
| D4342 |
|
62 |
26 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
26 |
$3K |
| D1351 |
Sealant - per tooth |
43 |
12 |
$1K |
| D1201 |
|
12 |
12 |
$0.00 |