| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,069 |
4,949 |
$266K |
| D2740 |
Crown - porcelain/ceramic |
334 |
215 |
$218K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
231 |
156 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
5,258 |
5,142 |
$125K |
| D0274 |
Bitewings - four radiographic images |
2,263 |
2,217 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,235 |
556 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,129 |
2,097 |
$61K |
| D1120 |
Prophylaxis - child |
1,269 |
1,241 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,116 |
1,096 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
613 |
596 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
420 |
279 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,579 |
1,515 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
400 |
379 |
$15K |
| D9110 |
|
178 |
172 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
40 |
$6K |
| D1351 |
Sealant - per tooth |
168 |
46 |
$6K |
| D2950 |
|
38 |
25 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
422 |
337 |
$5K |
| D0272 |
Bitewings - two radiographic images |
97 |
95 |
$3K |
| D7111 |
|
27 |
12 |
$2K |