| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,349 |
2,332 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,308 |
2,295 |
$149K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,472 |
4,481 |
$101K |
| D1110 |
Prophylaxis - adult |
1,078 |
1,066 |
$95K |
| D1120 |
Prophylaxis - child |
2,074 |
2,056 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
979 |
605 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,771 |
2,758 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,209 |
4,175 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
196 |
149 |
$23K |
| D2740 |
Crown - porcelain/ceramic |
43 |
36 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
340 |
338 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
861 |
854 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
172 |
106 |
$9K |
| D9430 |
|
253 |
246 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
70 |
$7K |
| D0272 |
Bitewings - two radiographic images |
305 |
294 |
$3K |
| D0350 |
|
299 |
178 |
$3K |
| D4341 |
|
39 |
13 |
$3K |
| D9993 |
|
29 |
29 |
$2K |
| D1310 |
|
29 |
29 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |