| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,373 |
3,162 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
5,158 |
4,884 |
$127K |
| D1120 |
Prophylaxis - child |
2,576 |
2,476 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,401 |
863 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,721 |
858 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,415 |
3,242 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,511 |
2,318 |
$87K |
| D1351 |
Sealant - per tooth |
1,779 |
587 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,248 |
1,165 |
$48K |
| D2740 |
Crown - porcelain/ceramic |
50 |
29 |
$36K |
| D0272 |
Bitewings - two radiographic images |
998 |
962 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
652 |
629 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
378 |
372 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,574 |
1,475 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
139 |
111 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
199 |
134 |
$17K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
13 |
$9K |
| D2950 |
|
47 |
28 |
$7K |
| D2335 |
|
44 |
26 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
238 |
142 |
$2K |
| D7111 |
|
36 |
24 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$1K |
| D1999 |
|
19 |
17 |
$0.00 |