| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,151 |
3,099 |
$165K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
245 |
163 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
3,425 |
3,367 |
$78K |
| D0272 |
Bitewings - two radiographic images |
2,995 |
2,942 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
2,695 |
2,534 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,005 |
984 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
242 |
118 |
$18K |
| D1120 |
Prophylaxis - child |
340 |
332 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
168 |
86 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
231 |
224 |
$10K |
| D9110 |
|
107 |
97 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
24 |
$316.00 |