| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,565 |
2,556 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,107 |
2,097 |
$131K |
| D1120 |
Prophylaxis - child |
2,797 |
2,782 |
$111K |
| D0210 |
Intraoral - complete series of radiographic images |
1,589 |
1,580 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
807 |
417 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,025 |
3,650 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,836 |
1,830 |
$39K |
| D1110 |
Prophylaxis - adult |
277 |
276 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,881 |
1,871 |
$21K |
| D9430 |
|
645 |
630 |
$21K |
| D1206 |
Topical application of fluoride varnish |
750 |
748 |
$13K |
| D4910 |
|
163 |
162 |
$12K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
21 |
12 |
$10K |
| D0272 |
Bitewings - two radiographic images |
666 |
665 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
39 |
$6K |
| D4341 |
|
73 |
24 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
117 |
108 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
255 |
253 |
$3K |
| D1310 |
|
37 |
37 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
40 |
40 |
$415.00 |
| D0601 |
|
24 |
24 |
$360.00 |
| D1999 |
|
762 |
701 |
$120.00 |
| D9993 |
|
13 |
13 |
$0.00 |