| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,909 |
3,748 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,417 |
1,417 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,487 |
3,353 |
$95K |
| D0330 |
Panoramic radiographic image |
2,465 |
2,365 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,825 |
3,669 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,769 |
2,650 |
$57K |
| D4341 |
|
592 |
249 |
$42K |
| D2740 |
Crown - porcelain/ceramic |
72 |
55 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
796 |
493 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
926 |
883 |
$30K |
| D1120 |
Prophylaxis - child |
500 |
480 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
520 |
510 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
521 |
169 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,674 |
2,420 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,221 |
1,166 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
197 |
144 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
142 |
44 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
498 |
341 |
$3K |
| D2950 |
|
14 |
13 |
$1K |
| D2331 |
|
20 |
13 |
$1K |
| D2330 |
|
21 |
12 |
$761.64 |
| D9986 |
|
29 |
28 |
$48.00 |
| D1330 |
|
21 |
21 |
$0.00 |