| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,580 |
1,536 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
851 |
535 |
$67K |
| D2740 |
Crown - porcelain/ceramic |
74 |
53 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,199 |
1,174 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
284 |
98 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
953 |
900 |
$36K |
| D0330 |
Panoramic radiographic image |
466 |
452 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
716 |
668 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,062 |
1,044 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
332 |
209 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
217 |
202 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
767 |
725 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
69 |
50 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
515 |
213 |
$4K |
| D1206 |
Topical application of fluoride varnish |
160 |
159 |
$4K |
| D0180 |
|
106 |
101 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
68 |
66 |
$2K |
| D1120 |
Prophylaxis - child |
37 |
36 |
$2K |