| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,630 |
8,440 |
$445K |
| D0330 |
Panoramic radiographic image |
4,602 |
4,465 |
$257K |
| D2740 |
Crown - porcelain/ceramic |
358 |
254 |
$229K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,693 |
4,564 |
$194K |
| D0120 |
Periodic oral evaluation - established patient |
6,868 |
6,754 |
$160K |
| D0274 |
Bitewings - four radiographic images |
5,393 |
5,266 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,163 |
3,104 |
$89K |
| D1120 |
Prophylaxis - child |
1,706 |
1,670 |
$84K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
611 |
357 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
1,389 |
1,330 |
$53K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
79 |
56 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
354 |
240 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,898 |
1,833 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
310 |
207 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
176 |
$22K |
| D2950 |
|
104 |
85 |
$17K |
| D9110 |
|
429 |
417 |
$16K |
| D2140 |
|
139 |
89 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
139 |
78 |
$9K |
| D1351 |
Sealant - per tooth |
184 |
40 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
87 |
69 |
$879.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$326.00 |