| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,914 |
2,766 |
$150K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
209 |
138 |
$113K |
| D2740 |
Crown - porcelain/ceramic |
117 |
91 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,142 |
2,062 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
865 |
819 |
$59K |
| D1120 |
Prophylaxis - child |
1,078 |
1,027 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,122 |
2,027 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
490 |
291 |
$43K |
| D2950 |
|
242 |
191 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
823 |
800 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,194 |
1,126 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
711 |
627 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
197 |
85 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
330 |
170 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
834 |
806 |
$12K |
| D0330 |
Panoramic radiographic image |
176 |
167 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
27 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
243 |
216 |
$3K |
| D1351 |
Sealant - per tooth |
71 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
29 |
28 |
$840.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
64 |
50 |
$740.00 |