| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,405 |
4,346 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,216 |
1,560 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
2,422 |
2,392 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
4,325 |
4,256 |
$55K |
| D2954 |
|
675 |
585 |
$46K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
366 |
326 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,300 |
953 |
$37K |
| D2740 |
Crown - porcelain/ceramic |
100 |
83 |
$27K |
| D0274 |
Bitewings - four radiographic images |
2,428 |
2,360 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
4,574 |
4,468 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
2,096 |
2,044 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,260 |
2,231 |
$20K |
| D1120 |
Prophylaxis - child |
830 |
827 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
137 |
51 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,424 |
3,219 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
654 |
643 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
303 |
266 |
$8K |
| D0272 |
Bitewings - two radiographic images |
398 |
398 |
$4K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
111 |
18 |
$2K |
| D0270 |
|
408 |
402 |
$1K |
| D1206 |
Topical application of fluoride varnish |
183 |
181 |
$600.00 |
| D9310 |
|
39 |
39 |
$225.17 |
| D2331 |
|
18 |
13 |
$204.00 |