| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,939 |
1,883 |
$101K |
| D0330 |
Panoramic radiographic image |
975 |
943 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,182 |
2,113 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
556 |
260 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
913 |
893 |
$26K |
| D2740 |
Crown - porcelain/ceramic |
27 |
25 |
$19K |
| D4341 |
|
152 |
57 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
280 |
157 |
$18K |
| D1120 |
Prophylaxis - child |
371 |
362 |
$17K |
| D2954 |
|
62 |
53 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
753 |
515 |
$11K |
| D0180 |
|
241 |
232 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
113 |
81 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
206 |
191 |
$7K |
| D0272 |
Bitewings - two radiographic images |
234 |
230 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
25 |
$4K |
| D1999 |
|
18 |
18 |
$0.00 |