| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,054 |
4,982 |
$174K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,212 |
7,114 |
$143K |
| D0274 |
Bitewings - four radiographic images |
4,399 |
4,362 |
$133K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,669 |
1,174 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
5,014 |
4,917 |
$111K |
| D1120 |
Prophylaxis - child |
2,466 |
2,436 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,304 |
843 |
$76K |
| D0140 |
Limited oral evaluation - problem focused |
2,569 |
2,540 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
670 |
549 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
1,135 |
1,109 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,335 |
2,615 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
99 |
54 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
15 |
$8K |
| D2330 |
|
150 |
91 |
$8K |
| D2394 |
|
27 |
24 |
$3K |
| D2954 |
|
14 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
168 |
167 |
$2K |
| D2331 |
|
25 |
12 |
$1K |
| D2140 |
|
19 |
14 |
$938.60 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$706.24 |