| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,414 |
3,413 |
$188K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,727 |
1,415 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
4,282 |
4,281 |
$118K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
890 |
751 |
$103K |
| D2740 |
Crown - porcelain/ceramic |
156 |
150 |
$101K |
| D1120 |
Prophylaxis - child |
1,971 |
1,971 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,953 |
1,877 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
596 |
560 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,801 |
1,801 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,521 |
1,521 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
617 |
575 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,710 |
2,710 |
$37K |
| D2394 |
|
208 |
181 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,954 |
1,829 |
$24K |
| D0330 |
Panoramic radiographic image |
543 |
543 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
735 |
713 |
$7K |
| D0272 |
Bitewings - two radiographic images |
334 |
334 |
$5K |
| D4910 |
|
84 |
84 |
$4K |
| D1206 |
Topical application of fluoride varnish |
161 |
161 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
137 |
$2K |
| D4342 |
|
27 |
25 |
$1K |
| D1320 |
|
24 |
24 |
$186.24 |