| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,352 |
6,170 |
$319K |
| D0120 |
Periodic oral evaluation - established patient |
7,218 |
7,056 |
$177K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,111 |
684 |
$141K |
| D0274 |
Bitewings - four radiographic images |
2,929 |
2,837 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
2,375 |
2,270 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,604 |
1,548 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,243 |
2,197 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,018 |
2,849 |
$48K |
| D0330 |
Panoramic radiographic image |
818 |
786 |
$39K |
| D1120 |
Prophylaxis - child |
946 |
936 |
$35K |
| D2740 |
Crown - porcelain/ceramic |
44 |
41 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
423 |
200 |
$30K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
38 |
38 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
65 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
949 |
864 |
$9K |
| D2950 |
|
50 |
48 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
41 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$833.04 |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$825.75 |
| D1999 |
|
2,072 |
1,943 |
$578.00 |