| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,347 |
3,661 |
$196K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,597 |
1,043 |
$143K |
| D2740 |
Crown - porcelain/ceramic |
198 |
149 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,233 |
767 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,679 |
2,316 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,991 |
3,391 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
4,704 |
3,971 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,632 |
1,368 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,517 |
1,352 |
$56K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
436 |
213 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
798 |
691 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,737 |
1,563 |
$46K |
| D1120 |
Prophylaxis - child |
1,062 |
921 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,573 |
2,989 |
$42K |
| D2950 |
|
176 |
135 |
$28K |
| D2330 |
|
450 |
117 |
$20K |
| D1351 |
Sealant - per tooth |
262 |
74 |
$10K |
| D4342 |
|
50 |
16 |
$4K |
| D2954 |
|
21 |
12 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
28 |
$3K |