| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,522 |
3,440 |
$187K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,679 |
626 |
$117K |
| D0274 |
Bitewings - four radiographic images |
2,886 |
2,830 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,030 |
1,988 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,163 |
1,140 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
2,114 |
2,043 |
$81K |
| D2740 |
Crown - porcelain/ceramic |
122 |
97 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
3,055 |
2,998 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
4,566 |
4,403 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,612 |
1,596 |
$47K |
| D1120 |
Prophylaxis - child |
866 |
857 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,839 |
2,646 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
450 |
308 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
465 |
273 |
$26K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
24 |
24 |
$14K |
| D2950 |
|
50 |
40 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$8K |
| D1351 |
Sealant - per tooth |
133 |
29 |
$5K |
| D2954 |
|
16 |
16 |
$3K |
| D2330 |
|
23 |
13 |
$2K |