| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,501 |
4,327 |
$229K |
| D2740 |
Crown - porcelain/ceramic |
316 |
210 |
$215K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,457 |
803 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,617 |
2,476 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,789 |
909 |
$107K |
| D0274 |
Bitewings - four radiographic images |
2,635 |
2,532 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,553 |
3,464 |
$86K |
| D1120 |
Prophylaxis - child |
1,705 |
1,622 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,471 |
2,406 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
3,690 |
3,434 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,182 |
1,130 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
259 |
160 |
$35K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
62 |
39 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,269 |
1,970 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
374 |
354 |
$25K |
| D2950 |
|
121 |
91 |
$18K |
| D1351 |
Sealant - per tooth |
199 |
54 |
$7K |
| D2332 |
|
21 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
44 |
41 |
$1K |