| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,556 |
1,519 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,608 |
1,214 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,329 |
2,272 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,496 |
1,410 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
609 |
591 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
467 |
259 |
$33K |
| D0274 |
Bitewings - four radiographic images |
914 |
893 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
970 |
950 |
$23K |
| D2954 |
|
150 |
95 |
$20K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
27 |
13 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
102 |
65 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
794 |
756 |
$9K |
| D1120 |
Prophylaxis - child |
102 |
100 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
70 |
37 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
24 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
106 |
37 |
$1K |