| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,625 |
9,616 |
$322K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
651 |
481 |
$236K |
| D0120 |
Periodic oral evaluation - established patient |
10,359 |
10,340 |
$192K |
| D6010 |
|
146 |
42 |
$146K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,732 |
10,716 |
$130K |
| D0210 |
Intraoral - complete series of radiographic images |
8,831 |
8,784 |
$122K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,665 |
1,307 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
10,733 |
10,706 |
$94K |
| D2954 |
|
866 |
632 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,737 |
1,014 |
$61K |
| D4342 |
|
2,195 |
982 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
976 |
683 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,086 |
1,085 |
$21K |
| D3310 |
|
83 |
62 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
210 |
170 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
1,239 |
1,234 |
$12K |
| D3320 |
|
47 |
38 |
$7K |
| D4341 |
|
166 |
64 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
286 |
286 |
$3K |
| D2331 |
|
39 |
27 |
$2K |
| D2332 |
|
23 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
52 |
51 |
$1K |
| D2330 |
|
33 |
14 |
$1K |