| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,790 |
1,774 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,072 |
2,061 |
$124K |
| D2740 |
Crown - porcelain/ceramic |
240 |
172 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
1,893 |
1,877 |
$86K |
| D1120 |
Prophylaxis - child |
1,002 |
999 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,829 |
2,011 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
460 |
222 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,152 |
1,149 |
$26K |
| D2140 |
|
420 |
163 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,059 |
1,055 |
$20K |
| D9430 |
|
641 |
630 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
147 |
66 |
$17K |
| D2954 |
|
157 |
117 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
281 |
115 |
$16K |
| D2330 |
|
143 |
76 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
176 |
95 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
847 |
847 |
$7K |
| D3320 |
|
13 |
12 |
$5K |
| D1351 |
Sealant - per tooth |
169 |
49 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
279 |
279 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
28 |
$2K |
| D2160 |
|
18 |
12 |
$1K |
| D0350 |
|
146 |
76 |
$1K |