| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,725 |
4,723 |
$257K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,587 |
4,581 |
$113K |
| D0274 |
Bitewings - four radiographic images |
3,263 |
3,263 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,459 |
3,459 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
3,274 |
3,266 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,357 |
1,357 |
$40K |
| D0330 |
Panoramic radiographic image |
911 |
911 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
1,583 |
1,578 |
$29K |
| D4341 |
|
293 |
104 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
808 |
808 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
15 |
13 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
129 |
91 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
105 |
82 |
$5K |
| D9310 |
|
54 |
54 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
28 |
$3K |
| D1120 |
Prophylaxis - child |
61 |
61 |
$3K |
| D9239 |
|
24 |
24 |
$2K |