| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,049 |
2,027 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,278 |
697 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
1,593 |
1,547 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
687 |
372 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
1,955 |
1,937 |
$60K |
| D1120 |
Prophylaxis - child |
977 |
959 |
$52K |
| D2740 |
Crown - porcelain/ceramic |
58 |
52 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
647 |
634 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,279 |
1,259 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
915 |
900 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
313 |
210 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,275 |
1,258 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
981 |
950 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
99 |
49 |
$334.80 |