| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,088 |
2,065 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
573 |
310 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,386 |
2,368 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,122 |
1,108 |
$45K |
| D1120 |
Prophylaxis - child |
1,117 |
1,114 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,632 |
1,628 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
428 |
264 |
$36K |
| D2740 |
Crown - porcelain/ceramic |
49 |
39 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,042 |
1,937 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
571 |
431 |
$26K |
| D0274 |
Bitewings - four radiographic images |
769 |
758 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,695 |
1,250 |
$13K |
| D2950 |
|
65 |
51 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
90 |
26 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
81 |
$3K |
| D0272 |
Bitewings - two radiographic images |
136 |
135 |
$3K |