| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,895 |
2,856 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,680 |
959 |
$119K |
| D2740 |
Crown - porcelain/ceramic |
134 |
100 |
$107K |
| D0274 |
Bitewings - four radiographic images |
3,177 |
3,111 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
3,174 |
3,120 |
$70K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
841 |
557 |
$70K |
| D0330 |
Panoramic radiographic image |
1,085 |
1,069 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,858 |
1,830 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
660 |
417 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,874 |
1,857 |
$37K |
| D1120 |
Prophylaxis - child |
1,081 |
1,069 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,856 |
3,784 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,868 |
3,604 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
179 |
80 |
$20K |
| D2394 |
|
168 |
133 |
$19K |
| D0240 |
|
1,016 |
493 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
760 |
337 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
56 |
30 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
48 |
48 |
$2K |
| D0272 |
Bitewings - two radiographic images |
75 |
75 |
$1K |
| D2160 |
|
17 |
13 |
$1K |