| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,283 |
4,679 |
$248K |
| D1120 |
Prophylaxis - child |
2,764 |
2,558 |
$128K |
| D0274 |
Bitewings - four radiographic images |
3,726 |
3,317 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,079 |
2,677 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
5,080 |
4,661 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,852 |
950 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,458 |
3,162 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
2,323 |
2,055 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,203 |
1,070 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
897 |
569 |
$63K |
| D2740 |
Crown - porcelain/ceramic |
64 |
52 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
608 |
263 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
321 |
136 |
$34K |
| D8670 |
Periodic orthodontic treatment visit |
86 |
84 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,552 |
1,407 |
$21K |
| D0272 |
Bitewings - two radiographic images |
467 |
414 |
$12K |
| D9310 |
|
294 |
189 |
$11K |
| D2950 |
|
76 |
53 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
12 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
54 |
$6K |
| D8690 |
|
25 |
25 |
$3K |
| D8660 |
|
111 |
60 |
$3K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
26 |
$246.00 |