| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,057 |
2,008 |
$86K |
| D2740 |
Crown - porcelain/ceramic |
151 |
87 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,869 |
2,818 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
750 |
491 |
$54K |
| D1120 |
Prophylaxis - child |
1,149 |
1,134 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,444 |
1,425 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
332 |
198 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
422 |
414 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
188 |
68 |
$18K |
| D0274 |
Bitewings - four radiographic images |
690 |
680 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
275 |
125 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
585 |
566 |
$12K |
| D1206 |
Topical application of fluoride varnish |
624 |
614 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
389 |
385 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
149 |
41 |
$10K |
| D0330 |
Panoramic radiographic image |
241 |
237 |
$8K |
| D2335 |
|
83 |
26 |
$7K |
| D0272 |
Bitewings - two radiographic images |
289 |
284 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
400 |
382 |
$5K |
| D1354 |
|
583 |
40 |
$3K |
| D2332 |
|
38 |
14 |
$3K |
| D2331 |
|
26 |
13 |
$2K |
| D1330 |
|
49 |
48 |
$0.00 |