| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
4,526 |
4,481 |
$338K |
| D1110 |
Prophylaxis - adult |
4,180 |
4,079 |
$331K |
| D4341 |
|
4,345 |
1,230 |
$300K |
| D0120 |
Periodic oral evaluation - established patient |
4,111 |
4,019 |
$244K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
456 |
338 |
$214K |
| D9430 |
|
4,345 |
4,058 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,862 |
1,827 |
$117K |
| D0210 |
Intraoral - complete series of radiographic images |
2,434 |
2,397 |
$111K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,945 |
11,906 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,826 |
5,697 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,132 |
508 |
$61K |
| D1120 |
Prophylaxis - child |
1,600 |
1,572 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,293 |
2,244 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,916 |
3,515 |
$41K |
| D0270 |
|
8,190 |
7,696 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
284 |
202 |
$32K |
| D4342 |
|
587 |
207 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
435 |
247 |
$20K |
| D9110 |
|
354 |
331 |
$20K |
| D2952 |
|
155 |
120 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
214 |
123 |
$12K |
| D2330 |
|
117 |
64 |
$9K |
| D2140 |
|
58 |
40 |
$3K |
| D2160 |
|
34 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
54 |
51 |
$254.00 |