| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,230 |
3,212 |
$194K |
| D1110 |
Prophylaxis - adult |
2,169 |
2,151 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
3,223 |
3,211 |
$166K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,942 |
5,432 |
$114K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,698 |
1,070 |
$113K |
| D0274 |
Bitewings - four radiographic images |
3,865 |
3,836 |
$81K |
| D4341 |
|
1,113 |
424 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
1,563 |
1,548 |
$66K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
121 |
99 |
$57K |
| D1120 |
Prophylaxis - child |
1,718 |
1,704 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
932 |
399 |
$53K |
| D2160 |
|
612 |
433 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
225 |
142 |
$26K |
| D9430 |
|
725 |
702 |
$22K |
| D2140 |
|
300 |
215 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,263 |
1,238 |
$15K |
| D0350 |
|
1,382 |
815 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,347 |
1,341 |
$12K |
| D2330 |
|
117 |
77 |
$9K |
| D0272 |
Bitewings - two radiographic images |
273 |
271 |
$3K |
| D4342 |
|
60 |
26 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
27 |
$2K |
| D2335 |
|
15 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
12 |
$1K |