| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,532 |
9,521 |
$404K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,416 |
2,865 |
$287K |
| D0274 |
Bitewings - four radiographic images |
9,857 |
9,852 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
9,746 |
9,744 |
$212K |
| D0220 |
Intraoral - periapical first radiographic image |
12,743 |
12,370 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,052 |
11,823 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
858 |
763 |
$57K |
| D9310 |
|
959 |
955 |
$48K |
| D2954 |
|
475 |
445 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,341 |
3,336 |
$34K |
| D2331 |
|
455 |
362 |
$32K |
| D1120 |
Prophylaxis - child |
854 |
854 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
761 |
760 |
$16K |
| D1320 |
|
1,596 |
1,593 |
$12K |
| D2332 |
|
88 |
66 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
378 |
369 |
$4K |
| D0272 |
Bitewings - two radiographic images |
250 |
250 |
$3K |
| D3320 |
|
14 |
14 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
38 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
173 |
153 |
$1K |
| D7510 |
|
14 |
14 |
$637.16 |
| D1206 |
Topical application of fluoride varnish |
34 |
34 |
$239.94 |
| D9110 |
|
14 |
12 |
$162.70 |