| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,817 |
3,778 |
$125K |
| D0274 |
Bitewings - four radiographic images |
3,677 |
3,641 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,527 |
570 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,199 |
752 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,414 |
720 |
$63K |
| D2740 |
Crown - porcelain/ceramic |
138 |
103 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,185 |
2,155 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
2,061 |
2,039 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
4,413 |
4,298 |
$33K |
| D5214 |
|
68 |
68 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,909 |
3,813 |
$30K |
| D1351 |
Sealant - per tooth |
1,222 |
147 |
$28K |
| D5213 |
|
51 |
50 |
$23K |
| D9110 |
|
684 |
658 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
258 |
257 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
176 |
143 |
$10K |
| D2331 |
|
188 |
120 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
400 |
385 |
$6K |
| D2330 |
|
143 |
66 |
$6K |
| D0601 |
|
310 |
309 |
$3K |
| D1120 |
Prophylaxis - child |
125 |
124 |
$3K |
| D1330 |
|
427 |
426 |
$2K |
| D1999 |
|
34 |
32 |
$0.00 |