| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,278 |
3,089 |
$167K |
| D0120 |
Periodic oral evaluation - established patient |
3,025 |
2,847 |
$67K |
| D2740 |
Crown - porcelain/ceramic |
94 |
57 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
894 |
818 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
966 |
879 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,009 |
868 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
477 |
277 |
$35K |
| D0274 |
Bitewings - four radiographic images |
936 |
899 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,186 |
1,122 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
541 |
201 |
$25K |
| D1120 |
Prophylaxis - child |
311 |
283 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
786 |
735 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
12 |
$9K |
| D2950 |
|
49 |
28 |
$8K |
| D0330 |
Panoramic radiographic image |
156 |
123 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
12 |
$3K |
| D7311 |
|
24 |
13 |
$3K |
| D1330 |
|
203 |
199 |
$3K |
| D0180 |
|
17 |
17 |
$650.00 |
| D3120 |
|
17 |
12 |
$578.00 |
| D9450 |
|
14 |
14 |
$0.00 |