| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,521 |
2,220 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
633 |
380 |
$74K |
| D1110 |
Prophylaxis - adult |
1,450 |
1,330 |
$64K |
| D0330 |
Panoramic radiographic image |
1,226 |
1,117 |
$56K |
| D2740 |
Crown - porcelain/ceramic |
100 |
76 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,453 |
1,308 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,440 |
1,305 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,528 |
2,158 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,423 |
1,290 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
352 |
209 |
$22K |
| D0190 |
|
1,050 |
869 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
252 |
66 |
$16K |
| D5130 |
|
21 |
12 |
$10K |
| D2950 |
|
44 |
38 |
$5K |
| D1206 |
Topical application of fluoride varnish |
267 |
232 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
630 |
292 |
$4K |
| D1351 |
Sealant - per tooth |
159 |
42 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
15 |
$3K |
| D3120 |
|
179 |
120 |
$3K |
| D1120 |
Prophylaxis - child |
44 |
42 |
$1K |
| D9992 |
|
69 |
54 |
$860.93 |
| D0270 |
|
53 |
50 |
$853.02 |
| D1208 |
Topical application of fluoride, excluding varnish |
51 |
48 |
$829.71 |
| D0272 |
Bitewings - two radiographic images |
48 |
40 |
$778.61 |