| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,229 |
4,092 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
5,472 |
5,294 |
$102K |
| D2740 |
Crown - porcelain/ceramic |
120 |
87 |
$97K |
| D0274 |
Bitewings - four radiographic images |
3,599 |
3,484 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,436 |
3,326 |
$56K |
| D1120 |
Prophylaxis - child |
1,974 |
1,904 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
463 |
272 |
$38K |
| D0330 |
Panoramic radiographic image |
693 |
661 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
565 |
352 |
$35K |
| D1351 |
Sealant - per tooth |
1,161 |
350 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,005 |
946 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
636 |
606 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,412 |
1,354 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,840 |
1,713 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
31 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
77 |
42 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
584 |
295 |
$4K |
| D2160 |
|
55 |
37 |
$4K |
| D2950 |
|
14 |
13 |
$2K |