| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,824 |
2,809 |
$243K |
| D0120 |
Periodic oral evaluation - established patient |
3,341 |
3,328 |
$207K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
384 |
269 |
$182K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,361 |
1,356 |
$88K |
| D2335 |
|
632 |
334 |
$75K |
| D1120 |
Prophylaxis - child |
1,623 |
1,619 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,461 |
4,441 |
$59K |
| D2394 |
|
642 |
459 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
654 |
384 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,165 |
2,153 |
$46K |
| D9110 |
|
663 |
647 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
741 |
738 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,558 |
3,428 |
$35K |
| D4910 |
|
406 |
403 |
$31K |
| D2952 |
|
250 |
185 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,074 |
2,024 |
$25K |
| D4341 |
|
346 |
92 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
14 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
13 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D0350 |
|
19 |
12 |
$81.60 |
| D1999 |
|
102 |
100 |
$0.00 |