| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,126 |
3,809 |
$207K |
| D0274 |
Bitewings - four radiographic images |
5,416 |
5,048 |
$190K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,414 |
3,218 |
$147K |
| D2740 |
Crown - porcelain/ceramic |
213 |
153 |
$126K |
| D1120 |
Prophylaxis - child |
2,262 |
2,152 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
7,239 |
6,567 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,349 |
758 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
4,179 |
3,880 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,355 |
3,181 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,402 |
5,334 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
1,455 |
1,344 |
$54K |
| D1351 |
Sealant - per tooth |
1,240 |
290 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
898 |
440 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
288 |
263 |
$19K |
| D4342 |
|
196 |
64 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
176 |
83 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
76 |
49 |
$10K |
| D0330 |
Panoramic radiographic image |
143 |
131 |
$6K |
| D2950 |
|
30 |
25 |
$5K |
| D1203 |
|
14 |
12 |
$0.00 |
| D1330 |
|
35 |
34 |
$0.00 |