| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,589 |
2,542 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
730 |
365 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,683 |
2,645 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,449 |
1,430 |
$55K |
| D1120 |
Prophylaxis - child |
943 |
933 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,469 |
1,448 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
886 |
869 |
$41K |
| D2740 |
Crown - porcelain/ceramic |
42 |
25 |
$31K |
| D2950 |
|
123 |
63 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
741 |
703 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
130 |
49 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
140 |
137 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
231 |
226 |
$9K |
| D9110 |
|
140 |
135 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
13 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
25 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
301 |
280 |
$4K |