| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,964 |
1,946 |
$166K |
| D2330 |
|
1,838 |
843 |
$143K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
241 |
120 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
1,641 |
1,624 |
$105K |
| D4910 |
|
1,309 |
1,300 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,441 |
1,441 |
$90K |
| D9430 |
|
2,758 |
2,433 |
$87K |
| D5660 |
|
564 |
254 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,085 |
3,291 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
5,348 |
4,386 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
886 |
445 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,168 |
2,148 |
$46K |
| D5640 |
|
515 |
242 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
274 |
108 |
$33K |
| D4341 |
|
404 |
114 |
$28K |
| D1120 |
Prophylaxis - child |
655 |
646 |
$25K |
| D5520 |
|
255 |
98 |
$18K |
| D2954 |
|
168 |
100 |
$18K |
| D5850 |
|
135 |
135 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
651 |
642 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
109 |
48 |
$7K |
| D5851 |
|
69 |
69 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
99 |
$5K |
| D9993 |
|
56 |
56 |
$4K |
| D1310 |
|
56 |
56 |
$3K |
| D5761 |
|
12 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
14 |
$2K |
| D5510 |
|
24 |
24 |
$2K |
| D5512 |
|
12 |
12 |
$840.00 |
| D0603 |
|
56 |
56 |
$825.00 |