| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,298 |
1,290 |
$85K |
| D1110 |
Prophylaxis - adult |
916 |
910 |
$80K |
| D0350 |
|
4,078 |
1,593 |
$54K |
| D9430 |
|
1,349 |
1,190 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
511 |
508 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
502 |
259 |
$40K |
| D2740 |
Crown - porcelain/ceramic |
79 |
62 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
428 |
210 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
514 |
509 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,153 |
1,578 |
$21K |
| D0274 |
Bitewings - four radiographic images |
841 |
834 |
$15K |
| D1120 |
Prophylaxis - child |
284 |
283 |
$15K |
| D1206 |
Topical application of fluoride varnish |
558 |
557 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
13 |
$8K |
| D4341 |
|
91 |
26 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
63 |
$5K |
| D0330 |
Panoramic radiographic image |
109 |
107 |
$3K |
| D2335 |
|
26 |
12 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
170 |
165 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
200 |
196 |
$2K |
| D4910 |
|
16 |
16 |
$1K |
| D9110 |
|
13 |
12 |
$819.00 |
| D0270 |
|
35 |
35 |
$175.00 |
| D3110 |
|
1,003 |
318 |
$0.00 |