| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,732 |
1,723 |
$76K |
| D2740 |
Crown - porcelain/ceramic |
70 |
55 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
544 |
286 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,744 |
1,728 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
936 |
920 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,188 |
1,182 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,419 |
2,395 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
890 |
881 |
$27K |
| D0330 |
Panoramic radiographic image |
765 |
751 |
$27K |
| D1120 |
Prophylaxis - child |
672 |
672 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
352 |
188 |
$25K |
| D2950 |
|
92 |
82 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
184 |
121 |
$14K |
| D1206 |
Topical application of fluoride varnish |
573 |
573 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,048 |
1,929 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
143 |
72 |
$6K |
| D4355 |
|
97 |
97 |
$6K |
| D2332 |
|
33 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
32 |
$2K |
| D7250 |
|
22 |
15 |
$1K |
| D9110 |
|
17 |
17 |
$234.00 |
| D0270 |
|
16 |
16 |
$223.20 |
| D0190 |
|
14 |
14 |
$94.00 |