| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,468 |
6,397 |
$347K |
| D2740 |
Crown - porcelain/ceramic |
475 |
320 |
$341K |
| D0330 |
Panoramic radiographic image |
3,626 |
3,599 |
$200K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,379 |
1,585 |
$192K |
| D0274 |
Bitewings - four radiographic images |
5,481 |
5,428 |
$158K |
| D0220 |
Intraoral - periapical first radiographic image |
11,305 |
10,531 |
$149K |
| D0140 |
Limited oral evaluation - problem focused |
3,613 |
3,553 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
5,979 |
5,918 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,391 |
632 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,802 |
650 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,237 |
2,217 |
$99K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,172 |
7,515 |
$89K |
| D1120 |
Prophylaxis - child |
1,435 |
1,418 |
$73K |
| D1206 |
Topical application of fluoride varnish |
2,257 |
2,242 |
$60K |
| D2950 |
|
277 |
190 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
808 |
802 |
$23K |
| D3320 |
|
33 |
26 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
90 |
80 |
$13K |
| D2332 |
|
103 |
24 |
$10K |
| D1351 |
Sealant - per tooth |
270 |
59 |
$10K |
| D0272 |
Bitewings - two radiographic images |
210 |
210 |
$5K |
| D9110 |
|
43 |
42 |
$2K |