| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
768 |
729 |
$63K |
| D0274 |
Bitewings - four radiographic images |
873 |
814 |
$48K |
| D0330 |
Panoramic radiographic image |
511 |
466 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
161 |
57 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
542 |
501 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
166 |
97 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
434 |
404 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,116 |
1,003 |
$25K |
| D2740 |
Crown - porcelain/ceramic |
35 |
16 |
$25K |
| D1206 |
Topical application of fluoride varnish |
891 |
840 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
426 |
369 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
38 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
242 |
236 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
38 |
$8K |
| D2950 |
|
18 |
14 |
$3K |