| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,695 |
2,633 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
2,656 |
2,612 |
$63K |
| D2740 |
Crown - porcelain/ceramic |
83 |
66 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
2,686 |
2,501 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,109 |
1,715 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
546 |
197 |
$36K |
| D0330 |
Panoramic radiographic image |
385 |
374 |
$25K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
39 |
28 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
546 |
538 |
$16K |
| D0272 |
Bitewings - two radiographic images |
597 |
588 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
136 |
67 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
230 |
225 |
$10K |
| D2954 |
|
38 |
27 |
$7K |
| D1120 |
Prophylaxis - child |
111 |
108 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
12 |
$2K |