| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,954 |
2,922 |
$107K |
| D4910 |
|
1,753 |
1,739 |
$105K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,363 |
821 |
$93K |
| D2740 |
Crown - porcelain/ceramic |
241 |
174 |
$88K |
| D1206 |
Topical application of fluoride varnish |
4,835 |
4,771 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
3,636 |
3,604 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
1,273 |
1,242 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
969 |
302 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,405 |
2,647 |
$48K |
| D0274 |
Bitewings - four radiographic images |
2,765 |
2,736 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,834 |
1,815 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,699 |
3,611 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
623 |
346 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
270 |
196 |
$20K |
| D2950 |
|
118 |
79 |
$10K |
| D0603 |
|
1,633 |
1,612 |
$8K |
| D4341 |
|
64 |
29 |
$6K |
| D0330 |
Panoramic radiographic image |
905 |
896 |
$6K |
| D0602 |
|
898 |
893 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
85 |
84 |
$2K |
| D0601 |
|
12 |
12 |
$60.00 |