| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,415 |
8,081 |
$433K |
| D2740 |
Crown - porcelain/ceramic |
446 |
342 |
$307K |
| D0120 |
Periodic oral evaluation - established patient |
8,447 |
8,147 |
$193K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,915 |
681 |
$138K |
| D0274 |
Bitewings - four radiographic images |
3,464 |
3,368 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,593 |
1,189 |
$125K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
838 |
375 |
$120K |
| D0140 |
Limited oral evaluation - problem focused |
3,137 |
2,964 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
4,807 |
4,554 |
$72K |
| D1120 |
Prophylaxis - child |
1,431 |
1,383 |
$69K |
| D1206 |
Topical application of fluoride varnish |
1,959 |
1,885 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,697 |
3,387 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
664 |
641 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
910 |
889 |
$39K |
| D0330 |
Panoramic radiographic image |
541 |
509 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
484 |
359 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
63 |
$7K |
| D9110 |
|
175 |
169 |
$7K |
| D2331 |
|
19 |
15 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$216.00 |
| D1999 |
|
3,218 |
2,831 |
$0.00 |