| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,950 |
1,922 |
$153K |
| D0120 |
Periodic oral evaluation - established patient |
2,553 |
2,517 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,053 |
2,012 |
$120K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
216 |
167 |
$103K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
755 |
419 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
1,645 |
1,612 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,014 |
3,404 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,418 |
3,365 |
$50K |
| D1120 |
Prophylaxis - child |
1,415 |
1,385 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
759 |
498 |
$48K |
| D0274 |
Bitewings - four radiographic images |
2,004 |
1,975 |
$40K |
| D4341 |
|
573 |
155 |
$39K |
| D4910 |
|
434 |
428 |
$37K |
| D9430 |
|
1,073 |
976 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,978 |
1,879 |
$20K |
| D0350 |
|
1,237 |
834 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
114 |
$9K |
| D1320 |
|
354 |
351 |
$5K |
| D2952 |
|
35 |
24 |
$4K |
| D1351 |
Sealant - per tooth |
48 |
12 |
$991.00 |
| D1999 |
|
226 |
176 |
$990.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$284.00 |