| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,589 |
3,451 |
$180K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,814 |
962 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
4,137 |
4,010 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,545 |
804 |
$88K |
| D0274 |
Bitewings - four radiographic images |
2,243 |
2,162 |
$75K |
| D1120 |
Prophylaxis - child |
1,487 |
1,464 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,181 |
2,103 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,272 |
1,217 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,180 |
1,127 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
600 |
556 |
$39K |
| D1351 |
Sealant - per tooth |
642 |
192 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,704 |
1,611 |
$25K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
21 |
14 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
39 |
$7K |
| D0272 |
Bitewings - two radiographic images |
286 |
285 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
566 |
332 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
38 |
$6K |
| D2950 |
|
16 |
13 |
$2K |
| D2330 |
|
37 |
24 |
$2K |