| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,123 |
4,091 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
3,117 |
3,081 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,851 |
911 |
$79K |
| D4341 |
|
1,380 |
518 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,013 |
464 |
$38K |
| D0274 |
Bitewings - four radiographic images |
3,263 |
3,221 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
894 |
863 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
4,911 |
4,812 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
600 |
600 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
758 |
748 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
34 |
27 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
182 |
89 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,856 |
3,740 |
$11K |
| D0180 |
|
338 |
319 |
$11K |
| D0330 |
Panoramic radiographic image |
788 |
770 |
$8K |
| D1120 |
Prophylaxis - child |
314 |
313 |
$7K |
| D7230 |
|
21 |
14 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
70 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
292 |
291 |
$3K |
| D2950 |
|
27 |
24 |
$2K |
| D9911 |
|
537 |
182 |
$1K |
| D9945 |
|
12 |
12 |
$360.00 |