| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,094 |
968 |
$80K |
| D2740 |
Crown - porcelain/ceramic |
63 |
29 |
$65K |
| D1110 |
Prophylaxis - adult |
1,434 |
1,304 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,306 |
1,182 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
2,219 |
2,015 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
482 |
267 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
373 |
103 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,093 |
1,005 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,116 |
1,380 |
$26K |
| D1120 |
Prophylaxis - child |
922 |
833 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
311 |
62 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
175 |
103 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,959 |
1,749 |
$16K |
| D0350 |
|
799 |
694 |
$13K |
| D2931 |
|
110 |
82 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
688 |
621 |
$12K |
| D1206 |
Topical application of fluoride varnish |
588 |
524 |
$11K |
| D2950 |
|
72 |
45 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
36 |
$4K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
14 |
$488.58 |
| D0272 |
Bitewings - two radiographic images |
27 |
25 |
$378.00 |