| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,009 |
4,907 |
$212K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,248 |
3,173 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
4,964 |
4,859 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
1,468 |
1,431 |
$112K |
| D0274 |
Bitewings - four radiographic images |
3,631 |
3,569 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,511 |
4,282 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
6,602 |
6,368 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
513 |
303 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
2,084 |
2,031 |
$70K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
192 |
139 |
$30K |
| D2740 |
Crown - porcelain/ceramic |
51 |
40 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
278 |
153 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
166 |
48 |
$16K |
| D1206 |
Topical application of fluoride varnish |
386 |
378 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
246 |
244 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
14 |
$3K |
| D1120 |
Prophylaxis - child |
24 |
24 |
$714.24 |