| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,013 |
2,992 |
$178K |
| D1120 |
Prophylaxis - child |
3,259 |
3,244 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
5,068 |
5,035 |
$138K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,446 |
4,419 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,089 |
620 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
982 |
619 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
720 |
482 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
1,661 |
1,641 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,338 |
1,331 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,357 |
1,345 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
2,808 |
2,775 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,216 |
1,214 |
$36K |
| D1351 |
Sealant - per tooth |
806 |
204 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,384 |
1,346 |
$20K |
| D2740 |
Crown - porcelain/ceramic |
26 |
17 |
$19K |
| D7240 |
Removal of impacted tooth - completely bony |
47 |
15 |
$18K |
| D2950 |
|
98 |
79 |
$17K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
21 |
16 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
113 |
110 |
$9K |
| D7111 |
|
93 |
55 |
$7K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$3K |