| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,344 |
4,160 |
$229K |
| D0274 |
Bitewings - four radiographic images |
4,202 |
4,025 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,684 |
893 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
4,829 |
4,644 |
$114K |
| D0220 |
Intraoral - periapical first radiographic image |
6,646 |
6,279 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,129 |
5,367 |
$93K |
| D2740 |
Crown - porcelain/ceramic |
127 |
100 |
$92K |
| D1120 |
Prophylaxis - child |
1,554 |
1,468 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,424 |
2,349 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,119 |
669 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
1,740 |
1,665 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,437 |
1,386 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
520 |
494 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
187 |
98 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
154 |
102 |
$11K |
| D1351 |
Sealant - per tooth |
234 |
59 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
12 |
$9K |
| D0272 |
Bitewings - two radiographic images |
97 |
97 |
$3K |
| D2140 |
|
27 |
12 |
$2K |