| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,124 |
3,093 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
3,430 |
3,399 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
5,015 |
4,887 |
$61K |
| D0460 |
|
2,135 |
1,977 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,157 |
3,088 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,095 |
1,080 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,175 |
1,169 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
195 |
92 |
$27K |
| D2740 |
Crown - porcelain/ceramic |
24 |
14 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
116 |
115 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
219 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
24 |
$6K |
| D0180 |
|
115 |
115 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
14 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$3K |
| D2950 |
|
19 |
12 |
$2K |