| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,069 |
1,059 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
519 |
350 |
$46K |
| D0330 |
Panoramic radiographic image |
586 |
571 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
833 |
822 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,081 |
1,074 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
297 |
234 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
316 |
233 |
$25K |
| D2335 |
|
175 |
98 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
717 |
714 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
600 |
588 |
$20K |
| D2394 |
|
184 |
144 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,950 |
1,367 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,698 |
1,673 |
$14K |
| D2740 |
Crown - porcelain/ceramic |
16 |
13 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
110 |
51 |
$10K |
| D2332 |
|
50 |
39 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
61 |
$5K |
| D2330 |
|
35 |
27 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
80 |
79 |
$2K |