| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,900 |
1,847 |
$100K |
| D2740 |
Crown - porcelain/ceramic |
91 |
51 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,214 |
2,169 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
3,110 |
3,012 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,370 |
1,330 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
304 |
194 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,305 |
2,218 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
680 |
657 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
367 |
357 |
$15K |
| D1120 |
Prophylaxis - child |
257 |
251 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
288 |
285 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
129 |
80 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
38 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
78 |
75 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
24 |
$3K |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$702.00 |
| D1999 |
|
104 |
81 |
$0.00 |