| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,443 |
7,315 |
$391K |
| D0274 |
Bitewings - four radiographic images |
6,080 |
6,000 |
$224K |
| D0120 |
Periodic oral evaluation - established patient |
8,669 |
8,551 |
$206K |
| D0210 |
Intraoral - complete series of radiographic images |
2,257 |
2,196 |
$167K |
| D2740 |
Crown - porcelain/ceramic |
206 |
178 |
$144K |
| D1120 |
Prophylaxis - child |
2,881 |
2,843 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,683 |
1,319 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,716 |
1,254 |
$110K |
| D1206 |
Topical application of fluoride varnish |
3,862 |
3,821 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
1,909 |
1,795 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,451 |
1,408 |
$65K |
| D2394 |
|
364 |
281 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,525 |
1,440 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
243 |
193 |
$19K |
| D2335 |
|
71 |
50 |
$10K |
| D2332 |
|
51 |
38 |
$6K |
| D1351 |
Sealant - per tooth |
104 |
26 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38 |
26 |
$4K |
| D1999 |
|
456 |
409 |
$0.00 |