| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,785 |
1,773 |
$109K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
228 |
169 |
$107K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
693 |
342 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,059 |
1,049 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,122 |
2,652 |
$43K |
| D4341 |
|
537 |
149 |
$36K |
| D1120 |
Prophylaxis - child |
1,075 |
1,065 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
715 |
712 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
353 |
195 |
$23K |
| D9430 |
|
740 |
717 |
$23K |
| D1351 |
Sealant - per tooth |
613 |
158 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,416 |
1,405 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
263 |
131 |
$14K |
| D3320 |
|
37 |
31 |
$13K |
| D0274 |
Bitewings - four radiographic images |
666 |
659 |
$12K |
| D2954 |
|
91 |
66 |
$9K |
| D0330 |
Panoramic radiographic image |
357 |
356 |
$9K |
| D1320 |
|
551 |
549 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
19 |
16 |
$9K |
| D1110 |
Prophylaxis - adult |
106 |
105 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
529 |
510 |
$6K |
| D0340 |
|
102 |
102 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
51 |
26 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
73 |
60 |
$3K |
| D0350 |
|
278 |
123 |
$3K |
| D0272 |
Bitewings - two radiographic images |
233 |
232 |
$3K |
| D1310 |
|
62 |
61 |
$3K |
| D4342 |
|
63 |
18 |
$3K |
| D2140 |
|
44 |
26 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$1K |
| D0603 |
|
16 |
15 |
$210.00 |
| D1330 |
|
110 |
110 |
$0.00 |