| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,732 |
3,721 |
$245K |
| D1110 |
Prophylaxis - adult |
2,239 |
2,231 |
$196K |
| D0210 |
Intraoral - complete series of radiographic images |
3,571 |
3,561 |
$170K |
| D2740 |
Crown - porcelain/ceramic |
307 |
236 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,910 |
977 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
949 |
942 |
$69K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
527 |
301 |
$61K |
| D1206 |
Topical application of fluoride varnish |
3,185 |
3,171 |
$52K |
| D4910 |
|
668 |
665 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
916 |
494 |
$49K |
| D4341 |
|
651 |
178 |
$46K |
| D9430 |
|
989 |
954 |
$31K |
| D1120 |
Prophylaxis - child |
557 |
552 |
$26K |
| D0274 |
Bitewings - four radiographic images |
911 |
909 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
25 |
25 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,819 |
1,684 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
53 |
$6K |
| D4342 |
|
119 |
39 |
$5K |
| D0270 |
|
369 |
362 |
$2K |
| D9110 |
|
29 |
25 |
$1K |
| D2330 |
|
19 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
101 |
100 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |