| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,428 |
2,340 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
1,654 |
1,607 |
$37K |
| D0274 |
Bitewings - four radiographic images |
723 |
703 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
605 |
566 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,102 |
990 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
196 |
179 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
219 |
125 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
143 |
101 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
12 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
37 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
139 |
129 |
$5K |
| D0180 |
|
100 |
98 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
137 |
132 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
171 |
126 |
$2K |
| D1120 |
Prophylaxis - child |
26 |
26 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |