| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,439 |
4,344 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
6,449 |
6,322 |
$114K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,464 |
851 |
$105K |
| D0274 |
Bitewings - four radiographic images |
3,787 |
3,699 |
$81K |
| D1120 |
Prophylaxis - child |
2,851 |
2,789 |
$74K |
| D1206 |
Topical application of fluoride varnish |
4,426 |
4,315 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,978 |
1,920 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
575 |
423 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
623 |
262 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
270 |
82 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
269 |
197 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,164 |
1,138 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,004 |
1,878 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
393 |
380 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
208 |
$9K |
| D0330 |
Panoramic radiographic image |
558 |
547 |
$8K |
| D4910 |
|
132 |
129 |
$8K |
| D2740 |
Crown - porcelain/ceramic |
13 |
12 |
$4K |
| D0601 |
|
780 |
764 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
658 |
417 |
$3K |
| D4341 |
|
24 |
12 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
96 |
93 |
$2K |
| D1351 |
Sealant - per tooth |
57 |
13 |
$1K |
| D0603 |
|
228 |
225 |
$1K |
| D0602 |
|
84 |
84 |
$410.00 |