| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,197 |
2,189 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
1,731 |
1,723 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,900 |
1,110 |
$126K |
| D1110 |
Prophylaxis - adult |
1,167 |
1,166 |
$100K |
| D0210 |
Intraoral - complete series of radiographic images |
1,934 |
1,925 |
$90K |
| D2740 |
Crown - porcelain/ceramic |
157 |
122 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,101 |
2,914 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
818 |
490 |
$44K |
| D1120 |
Prophylaxis - child |
910 |
909 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,428 |
1,421 |
$29K |
| D9430 |
|
872 |
850 |
$28K |
| D0350 |
|
2,947 |
1,119 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,896 |
1,881 |
$25K |
| D4341 |
|
278 |
98 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
157 |
81 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
138 |
93 |
$11K |
| D1206 |
Topical application of fluoride varnish |
404 |
404 |
$7K |
| D4910 |
|
54 |
54 |
$4K |
| D0330 |
Panoramic radiographic image |
688 |
686 |
$3K |
| D0270 |
|
425 |
410 |
$2K |
| D1351 |
Sealant - per tooth |
53 |
13 |
$2K |
| D2330 |
|
21 |
13 |
$2K |