| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,942 |
2,880 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,624 |
2,571 |
$58K |
| D2740 |
Crown - porcelain/ceramic |
127 |
89 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
2,029 |
1,887 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
884 |
439 |
$33K |
| D0274 |
Bitewings - four radiographic images |
2,677 |
2,607 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,158 |
1,138 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
584 |
350 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
4,785 |
4,528 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
527 |
511 |
$18K |
| D1120 |
Prophylaxis - child |
661 |
651 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,660 |
3,617 |
$15K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
35 |
31 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
228 |
110 |
$12K |
| D0330 |
Panoramic radiographic image |
464 |
442 |
$7K |
| D2750 |
|
15 |
12 |
$7K |
| D4341 |
|
142 |
51 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
13 |
$6K |
| D1206 |
Topical application of fluoride varnish |
364 |
359 |
$6K |
| D2954 |
|
31 |
24 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
163 |
162 |
$2K |
| D4355 |
|
17 |
17 |
$812.50 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$742.50 |
| D0272 |
Bitewings - two radiographic images |
43 |
42 |
$315.70 |
| D0270 |
|
38 |
38 |
$131.80 |
| D1330 |
|
470 |
416 |
$0.00 |