| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,108 |
1,071 |
$59K |
| D2740 |
Crown - porcelain/ceramic |
45 |
36 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
547 |
520 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
296 |
289 |
$22K |
| D0274 |
Bitewings - four radiographic images |
526 |
507 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
580 |
565 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
694 |
608 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
184 |
168 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
55 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
109 |
69 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
382 |
330 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
13 |
$4K |
| D2950 |
|
15 |
13 |
$3K |