| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4342 |
|
492 |
162 |
$45K |
| D1110 |
Prophylaxis - adult |
984 |
980 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
227 |
175 |
$36K |
| D4910 |
|
511 |
500 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
755 |
726 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,459 |
1,407 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
972 |
970 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,240 |
1,196 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
195 |
187 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
104 |
69 |
$14K |
| D0460 |
|
486 |
461 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
330 |
330 |
$12K |
| D0274 |
Bitewings - four radiographic images |
424 |
424 |
$12K |
| D7510 |
|
84 |
78 |
$8K |
| D2740 |
Crown - porcelain/ceramic |
17 |
12 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
513 |
511 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$3K |