| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,746 |
2,721 |
$149K |
| D1110 |
Prophylaxis - adult |
1,552 |
1,539 |
$128K |
| D4341 |
|
1,465 |
408 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,476 |
888 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,544 |
1,535 |
$95K |
| D1120 |
Prophylaxis - child |
2,249 |
2,224 |
$83K |
| D4910 |
|
1,041 |
1,030 |
$82K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
858 |
471 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,286 |
4,239 |
$56K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
472 |
298 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,546 |
3,638 |
$52K |
| D9430 |
|
1,746 |
1,614 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
784 |
482 |
$42K |
| D0350 |
|
4,171 |
1,999 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
818 |
797 |
$38K |
| D1351 |
Sealant - per tooth |
1,295 |
370 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,226 |
1,220 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,417 |
1,395 |
$16K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
34 |
27 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
186 |
149 |
$15K |
| D1320 |
|
783 |
779 |
$9K |
| D2140 |
|
144 |
90 |
$7K |
| D2160 |
|
31 |
25 |
$2K |
| D2954 |
|
16 |
12 |
$2K |
| D4342 |
|
33 |
12 |
$1K |