| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,330 |
2,079 |
$172K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
787 |
428 |
$119K |
| D0274 |
Bitewings - four radiographic images |
1,947 |
1,754 |
$101K |
| D2740 |
Crown - porcelain/ceramic |
128 |
111 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,087 |
987 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
2,931 |
2,622 |
$63K |
| D0330 |
Panoramic radiographic image |
694 |
626 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
998 |
903 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,405 |
1,282 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,134 |
1,888 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
342 |
194 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,634 |
1,438 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
48 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
50 |
14 |
$10K |
| D2950 |
|
41 |
39 |
$7K |
| D2331 |
|
36 |
24 |
$4K |
| D1120 |
Prophylaxis - child |
39 |
39 |
$2K |
| D2330 |
|
26 |
18 |
$2K |
| D4910 |
|
12 |
12 |
$1K |