| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,224 |
7,024 |
$386K |
| D2740 |
Crown - porcelain/ceramic |
450 |
290 |
$313K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,154 |
1,843 |
$255K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,395 |
1,669 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
8,037 |
7,817 |
$192K |
| D0274 |
Bitewings - four radiographic images |
5,607 |
5,458 |
$192K |
| D1120 |
Prophylaxis - child |
2,636 |
2,566 |
$131K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
859 |
474 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,992 |
3,920 |
$115K |
| D0330 |
Panoramic radiographic image |
1,383 |
1,354 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
995 |
957 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,570 |
1,519 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,592 |
1,518 |
$63K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
61 |
41 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
399 |
287 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,832 |
1,739 |
$26K |
| D2950 |
|
107 |
79 |
$17K |
| D0272 |
Bitewings - two radiographic images |
544 |
524 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
154 |
76 |
$14K |
| D1351 |
Sealant - per tooth |
199 |
54 |
$8K |
| D2330 |
|
87 |
40 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
317 |
161 |
$4K |
| D4342 |
|
34 |
14 |
$3K |
| D2331 |
|
14 |
12 |
$1K |
| D9410 |
|
20 |
20 |
$936.00 |
| D1999 |
|
166 |
158 |
$0.00 |