| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,532 |
2,512 |
$166K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,993 |
1,084 |
$133K |
| D1110 |
Prophylaxis - adult |
1,243 |
1,235 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
1,268 |
1,258 |
$94K |
| D0210 |
Intraoral - complete series of radiographic images |
1,858 |
1,841 |
$87K |
| D1120 |
Prophylaxis - child |
1,503 |
1,490 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,006 |
620 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,219 |
2,169 |
$38K |
| D4910 |
|
497 |
491 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,524 |
2,504 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
428 |
302 |
$34K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
57 |
41 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,283 |
1,273 |
$26K |
| D4341 |
|
325 |
88 |
$23K |
| D0350 |
|
2,034 |
1,392 |
$17K |
| D9430 |
|
334 |
318 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
57 |
27 |
$7K |
| D1351 |
Sealant - per tooth |
97 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
155 |
155 |
$2K |
| D2331 |
|
19 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
95 |
95 |
$1K |
| D1999 |
|
13 |
13 |
$46.00 |