| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,304 |
2,233 |
$118K |
| D0274 |
Bitewings - four radiographic images |
1,833 |
1,780 |
$62K |
| D2740 |
Crown - porcelain/ceramic |
64 |
42 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
975 |
941 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,769 |
1,719 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
456 |
442 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,921 |
1,871 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
438 |
232 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
275 |
156 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,604 |
1,445 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
137 |
55 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
367 |
348 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
383 |
367 |
$10K |
| D2950 |
|
65 |
50 |
$10K |
| D0330 |
Panoramic radiographic image |
125 |
109 |
$4K |
| D2330 |
|
34 |
24 |
$2K |
| D1120 |
Prophylaxis - child |
43 |
41 |
$2K |
| D2331 |
|
23 |
14 |
$2K |