| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
963 |
959 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,094 |
329 |
$59K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
123 |
79 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,475 |
2,093 |
$42K |
| D1120 |
Prophylaxis - child |
1,289 |
1,287 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
939 |
937 |
$38K |
| D1110 |
Prophylaxis - adult |
473 |
469 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
404 |
187 |
$27K |
| D4341 |
|
319 |
84 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
466 |
465 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,064 |
2,059 |
$21K |
| D9430 |
|
620 |
594 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,617 |
1,614 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
123 |
45 |
$14K |
| D0350 |
|
1,334 |
538 |
$12K |
| D2140 |
|
221 |
105 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
151 |
96 |
$10K |
| D4910 |
|
112 |
112 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
84 |
$8K |
| D2954 |
|
65 |
40 |
$7K |
| D1351 |
Sealant - per tooth |
260 |
66 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
28 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
268 |
235 |
$3K |
| D2330 |
|
26 |
13 |
$2K |
| D1330 |
|
28 |
28 |
$0.00 |