| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,490 |
2,480 |
$211K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,902 |
2,889 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
2,345 |
2,336 |
$142K |
| D2740 |
Crown - porcelain/ceramic |
279 |
212 |
$132K |
| D0210 |
Intraoral - complete series of radiographic images |
1,920 |
1,911 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,722 |
4,292 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,871 |
2,854 |
$59K |
| D9430 |
|
1,754 |
1,702 |
$55K |
| D1120 |
Prophylaxis - child |
1,281 |
1,267 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
550 |
371 |
$35K |
| D4341 |
|
502 |
137 |
$33K |
| D2160 |
|
357 |
201 |
$28K |
| D2954 |
|
225 |
173 |
$23K |
| D3320 |
|
55 |
46 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
226 |
144 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
939 |
939 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
172 |
116 |
$13K |
| D1351 |
Sealant - per tooth |
290 |
54 |
$8K |
| D2330 |
|
76 |
38 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
326 |
323 |
$4K |
| D0270 |
|
720 |
709 |
$4K |
| D4342 |
|
77 |
24 |
$3K |
| D1206 |
Topical application of fluoride varnish |
310 |
309 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
24 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
17 |
17 |
$156.00 |