| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,607 |
3,548 |
$149K |
| D2740 |
Crown - porcelain/ceramic |
284 |
213 |
$138K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,294 |
632 |
$116K |
| D0210 |
Intraoral - complete series of radiographic images |
1,884 |
1,824 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
4,633 |
4,563 |
$94K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
193 |
161 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,088 |
712 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
2,778 |
2,624 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
5,513 |
5,292 |
$38K |
| D1120 |
Prophylaxis - child |
1,228 |
1,223 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,360 |
1,338 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,669 |
1,627 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
457 |
325 |
$26K |
| D9310 |
|
806 |
771 |
$17K |
| D2950 |
|
178 |
147 |
$13K |
| D4341 |
|
136 |
55 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,078 |
2,796 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
113 |
82 |
$10K |
| D4910 |
|
132 |
129 |
$8K |
| D0270 |
|
1,011 |
982 |
$7K |
| D0330 |
Panoramic radiographic image |
335 |
324 |
$7K |
| D2954 |
|
38 |
32 |
$5K |
| D1206 |
Topical application of fluoride varnish |
813 |
809 |
$5K |
| D0272 |
Bitewings - two radiographic images |
333 |
333 |
$4K |
| D2332 |
|
40 |
25 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
25 |
$2K |
| D2335 |
|
22 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
104 |
14 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
72 |
72 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
25 |
$215.00 |