| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,450 |
1,370 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
1,802 |
1,708 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,411 |
1,333 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
286 |
146 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
981 |
940 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
941 |
906 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
235 |
96 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
359 |
350 |
$23K |
| D2740 |
Crown - porcelain/ceramic |
31 |
29 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
982 |
930 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
55 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
535 |
513 |
$8K |
| D1120 |
Prophylaxis - child |
199 |
180 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
12 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
13 |
$5K |
| D0330 |
Panoramic radiographic image |
95 |
89 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
15 |
$2K |
| D4910 |
|
26 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$507.66 |