| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,025 |
1,937 |
$107K |
| D2740 |
Crown - porcelain/ceramic |
142 |
83 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,435 |
1,369 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
713 |
331 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,990 |
1,898 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,103 |
1,037 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
581 |
537 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
409 |
231 |
$34K |
| D1120 |
Prophylaxis - child |
561 |
530 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
888 |
819 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
422 |
403 |
$16K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
29 |
12 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
915 |
848 |
$14K |
| D4341 |
|
35 |
13 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
13 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
173 |
140 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
39 |
37 |
$1K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$312.00 |