| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,005 |
3,828 |
$199K |
| D2740 |
Crown - porcelain/ceramic |
212 |
156 |
$154K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
926 |
425 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,558 |
913 |
$113K |
| D0140 |
Limited oral evaluation - problem focused |
3,047 |
2,853 |
$112K |
| D0274 |
Bitewings - four radiographic images |
3,126 |
2,993 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,319 |
2,220 |
$92K |
| D0330 |
Panoramic radiographic image |
1,504 |
1,433 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,901 |
2,787 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,000 |
527 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
3,881 |
3,642 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,780 |
1,987 |
$26K |
| D1120 |
Prophylaxis - child |
651 |
620 |
$26K |
| D1206 |
Topical application of fluoride varnish |
513 |
495 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
391 |
376 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
113 |
83 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
122 |
118 |
$8K |
| D2950 |
|
48 |
41 |
$8K |
| D4341 |
|
50 |
15 |
$7K |
| D7230 |
|
18 |
12 |
$5K |
| D2330 |
|
58 |
34 |
$4K |
| D1351 |
Sealant - per tooth |
196 |
25 |
$4K |
| D7220 |
|
14 |
12 |
$2K |
| D0270 |
|
135 |
133 |
$1K |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$666.00 |
| D9110 |
|
14 |
14 |
$462.00 |
| D1999 |
|
1,109 |
846 |
$0.00 |