| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,027 |
2,996 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
1,583 |
1,566 |
$70K |
| D2740 |
Crown - porcelain/ceramic |
143 |
109 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
684 |
507 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,023 |
2,000 |
$49K |
| D1206 |
Topical application of fluoride varnish |
2,299 |
2,277 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,920 |
1,900 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
554 |
120 |
$29K |
| D0274 |
Bitewings - four radiographic images |
2,932 |
2,897 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
4,122 |
4,011 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,798 |
3,148 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
143 |
114 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
148 |
108 |
$8K |
| D4341 |
|
71 |
25 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
252 |
241 |
$7K |
| D0330 |
Panoramic radiographic image |
1,970 |
1,945 |
$6K |
| D1999 |
|
627 |
597 |
$6K |
| D1120 |
Prophylaxis - child |
155 |
155 |
$4K |
| D4910 |
|
13 |
13 |
$878.15 |
| D0272 |
Bitewings - two radiographic images |
30 |
30 |
$267.69 |
| D0270 |
|
14 |
13 |
$91.17 |