| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,316 |
2,310 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,925 |
3,915 |
$89K |
| D2740 |
Crown - porcelain/ceramic |
129 |
89 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
4,812 |
4,712 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,442 |
1,434 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
362 |
202 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
428 |
427 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
322 |
125 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,010 |
1,010 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,570 |
1,557 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
300 |
300 |
$11K |
| D2950 |
|
47 |
28 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
24 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
13 |
$2K |