| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,659 |
1,652 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,244 |
1,231 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,188 |
1,177 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,504 |
1,499 |
$41K |
| D4355 |
|
377 |
376 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
945 |
936 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
326 |
161 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,956 |
1,853 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
192 |
81 |
$23K |
| D2950 |
|
125 |
98 |
$19K |
| D1120 |
Prophylaxis - child |
463 |
463 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
29 |
25 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
773 |
772 |
$18K |
| D0274 |
Bitewings - four radiographic images |
559 |
559 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,977 |
1,256 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
226 |
69 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
44 |
$8K |
| D2750 |
|
13 |
12 |
$2K |