| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,591 |
4,420 |
$234K |
| D2740 |
Crown - porcelain/ceramic |
282 |
229 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
4,642 |
4,491 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
2,419 |
2,311 |
$91K |
| D0274 |
Bitewings - four radiographic images |
2,557 |
2,477 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,130 |
735 |
$85K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
558 |
309 |
$74K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
127 |
99 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,598 |
1,543 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
926 |
891 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,090 |
591 |
$61K |
| D1120 |
Prophylaxis - child |
1,213 |
1,186 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,956 |
1,898 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
2,594 |
2,481 |
$37K |
| D2950 |
|
146 |
119 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
125 |
74 |
$9K |
| D2330 |
|
98 |
56 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
58 |
$6K |
| D1351 |
Sealant - per tooth |
156 |
39 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
440 |
289 |
$5K |
| D0272 |
Bitewings - two radiographic images |
113 |
112 |
$3K |
| D2954 |
|
19 |
14 |
$3K |
| D2332 |
|
24 |
16 |
$2K |
| D4342 |
|
43 |
12 |
$2K |
| D3120 |
|
60 |
41 |
$2K |
| D0270 |
|
20 |
18 |
$224.00 |