| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,546 |
1,533 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
1,714 |
1,699 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,248 |
1,236 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
890 |
878 |
$54K |
| D9430 |
|
1,574 |
1,505 |
$50K |
| D2740 |
Crown - porcelain/ceramic |
89 |
76 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
557 |
324 |
$37K |
| D4910 |
|
387 |
386 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,557 |
1,546 |
$26K |
| D1120 |
Prophylaxis - child |
666 |
660 |
$24K |
| D0274 |
Bitewings - four radiographic images |
946 |
934 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,605 |
1,514 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,225 |
1,771 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
112 |
64 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
181 |
111 |
$10K |
| D2954 |
|
64 |
54 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
535 |
526 |
$6K |
| D4341 |
|
33 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D1999 |
|
467 |
386 |
$46.00 |
| D0180 |
|
83 |
83 |
$0.00 |