| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,571 |
5,184 |
$280K |
| D2740 |
Crown - porcelain/ceramic |
356 |
193 |
$220K |
| D0120 |
Periodic oral evaluation - established patient |
6,961 |
6,499 |
$156K |
| D0274 |
Bitewings - four radiographic images |
4,059 |
3,734 |
$135K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
917 |
409 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
2,827 |
2,628 |
$104K |
| D1120 |
Prophylaxis - child |
2,020 |
1,968 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,310 |
3,060 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,216 |
1,150 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,910 |
1,793 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
707 |
424 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
3,699 |
3,434 |
$53K |
| D2950 |
|
325 |
161 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
373 |
222 |
$23K |
| D1351 |
Sealant - per tooth |
534 |
121 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
212 |
110 |
$17K |
| D0330 |
Panoramic radiographic image |
285 |
272 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,006 |
686 |
$11K |
| D0272 |
Bitewings - two radiographic images |
178 |
177 |
$5K |
| D7220 |
|
25 |
13 |
$5K |
| D4341 |
|
32 |
12 |
$3K |