| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,883 |
2,763 |
$153K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,071 |
860 |
$138K |
| D0140 |
Limited oral evaluation - problem focused |
2,733 |
2,605 |
$103K |
| D2740 |
Crown - porcelain/ceramic |
142 |
101 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,950 |
1,886 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,176 |
2,087 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
4,169 |
3,961 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
783 |
564 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,495 |
2,398 |
$59K |
| D1120 |
Prophylaxis - child |
1,152 |
1,109 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
775 |
490 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,469 |
1,414 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
472 |
459 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
238 |
132 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,324 |
2,082 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
68 |
$8K |
| D2950 |
|
53 |
38 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$7K |
| D5212 |
|
13 |
13 |
$7K |
| D1351 |
Sealant - per tooth |
172 |
31 |
$5K |
| D2335 |
|
12 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
47 |
46 |
$1K |