| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,233 |
3,099 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
2,940 |
2,842 |
$65K |
| D2740 |
Crown - porcelain/ceramic |
68 |
41 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
814 |
812 |
$24K |
| D0274 |
Bitewings - four radiographic images |
600 |
572 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,362 |
1,278 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
277 |
270 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
453 |
433 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
193 |
99 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
238 |
235 |
$10K |
| D1120 |
Prophylaxis - child |
195 |
195 |
$9K |
| D4381 |
|
112 |
12 |
$9K |
| D4341 |
|
37 |
14 |
$4K |
| D2954 |
|
21 |
13 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
94 |
66 |
$1K |