| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,897 |
3,880 |
$178K |
| D2740 |
Crown - porcelain/ceramic |
256 |
170 |
$166K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,008 |
3,004 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
884 |
330 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
2,811 |
2,798 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
799 |
796 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,848 |
1,842 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,089 |
2,083 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,940 |
4,877 |
$61K |
| D2950 |
|
279 |
210 |
$36K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
79 |
65 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
161 |
100 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
664 |
659 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
38 |
$10K |
| D4342 |
|
27 |
12 |
$3K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$357.12 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
17 |
$187.85 |